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Kidney Week

Abstract: TH-PO130

Clinical Advantage of Concomitant Use of Low Dose Mizoribine and Prednisolone on Primary Membranous Nephropathy in the Elderly

Session Information

Category: Glomerular

  • 1005 Clinical Glomerular Disorders

Authors

  • Hasegawa, Hajime, Study group for nephrotic syndrome in the elderly, Kawagoe, Japan
  • Mitarai, Tetsuya, Study group for nephrotic syndrome in the elderly, Kawagoe, Japan
  • Tomino, Yasuhiko, Study group for nephrotic syndrome in the elderly, Kawagoe, Japan
  • Yokoyama, Hitoshi, Study group for nephrotic syndrome in the elderly, Kawagoe, Japan
  • Yamagata, Kunihiro, Study group for nephrotic syndrome in the elderly, Kawagoe, Japan
  • Iwano, Masayuki, Study group for nephrotic syndrome in the elderly, Kawagoe, Japan
  • Akiyama, Shin'ichi, Study group for nephrotic syndrome in the elderly, Kawagoe, Japan
  • Takayanagi, Kaori, Study group for nephrotic syndrome in the elderly, Kawagoe, Japan
Background

Initial therapeutic strategy of membranous nephropathy (MN) in Japan is sole administration of Prednisolone (PSL) of 1 mg/kg for 4 weeks, and then addition of immunosuppressant such as Cyclosporin. However, long-term administration of high dose PSL and immunosupressant in elder patients is controversial because of their multiple adverse effects. Here, we show the clinical efficacy of concomitant use of lower dose of Mizoribine (MZB) and PSL in terms of earlier induction to the remission by multicentered prospective cohort study.

Methods

Thirty-six patients diagnosed primary MN showing nephrotic syndrome were enrolled from 24 independent facilities. The patients, being older than 65 of age and preliminary obtained none of therapy, were randomly assigned to two groups, solely administered 30 mg of PSL (P group, n=18), or concomitantly administered 150 mg of MZB (MP group, n=18) and observed for 12 months. Remission rate was evaluated by remission score (RS) as follows: 1: Urine protein-to-Cr ratio (PCR)≥3.5, 2: 3.5>PCR≥1.0, 3: 1.0>PCR≥0.3 and 4: PCR<0.3 g/gCr. In some cases, anti-phospholipase A2 receptor antibody (PLA2R-Ab) titer was qualitatively measured.

Results

Mean ages of MP and P groups were 73.3 and 72.8. PCR at 12M was not different in the two groups. However, %PCR vs baseline and RS at earlier phase of MP were better than P (%PCR: 3M 50.0±47.0% vs 55.6±57.0%, 6M 31.4±27.2% vs 39.9±33.1%, RS: 3M 1.24±1.20 vs 1.00±0.93, 6M 1.69±1.03 vs 1.07±1.00). Those results were confirmed by the logistic analysis showed estimated odds ratio of the high responder in MP group was 1.50 (95%CI=0.33-6.83), suggesting that the concomitant use of MZB might accelerate the remission. Additionally, in cases showing qualitatively negative PLA2R antibody, the odds ratio of high responder cases was 2.67 (95% CI: 0.28-25.64) in MP vs 1.00 in P whereas the odds ratio was 0.33 (MP) and 0.40 (P) in cases showing positive PLA2R-Ab, suggesting that concomitant use of MZB might be more effective in PLA2R-Ab negative cases.

Conclusion

Concomitant use of low dose of MZB and PSL might contribute to save time until remission in elder patients with MN-based NS.