Abstract: TH-OR022

Antibody Guided Therapy with Cyclophosphamide and Prednisone in Patients with Membranous Nephropathy

Session Information

Category: Glomerular

  • 1005 Clinical Glomerular Disorders

Authors

  • van de Logt, Anne-Els, Radboud University Medical Center, Nijmegen, Netherlands
  • Vink- van Setten, Coralien, Radboud University Medical Center, Nijmegen, Netherlands
  • Hofstra, Julia M., Hospital Gelderse Vallei, Ede, Netherlands
  • Wetzels, Jack F., Radboud University Medical Center, Nijmegen, Netherlands
Background

The discovery of anti-PLA2R antibodies provides options for individualized therapy in patients with membranous nephropathy (MN). We previously showed that monitoring of aPLA2R allowed shortening of the overall duration of cyclophosphamide (Cyc) treatment (van de Logt, Kidney week 2015). Here we present longer-term follow-up data.

Methods

Cyc-therapy (combined with steroids) is started in patients with aPLA2R positive MN and high risk of progression. In our antibody guided cohort aPLA2R are repeatedly monitored (IFT test) at 8, 16, and 24 weeks after start of treatment. If antibodies become negative, Cyc is stopped and prednisone is tapered. Otherwise, therapy is continued after 24 weeks with MMF and prednisone.

Results

Thus far 46 patients (30 males) are included; mean age was 57 ± 13 years, median creatinine 122 µmol/l (IQR 96-159), mean albumin 21.6 ± 6.8 g/l and protein-creatinine ratio 8.6 ±4.3 g/10 mmol. Follow-up duration was 22 ± 11 months. Time to disappearance of aPLA2R was on average short (median 2.1 month), however ranged from 1.4 to 14.6 months. As a consequence the median duration of treatment was 3.2 (range 1.4 to 16.6) months. Cumulative remission rates (PCR <3.0 g/10 mmol) were 52% and 76% respectively 6 and 12 months after start of therapy, not significantly different from historical controls (40% and 60%). The cumulative incidence of relapses at 12 months after onset of remission was 21% and after 24 months 30% in our cohort (respectively 16 % at 24 months in historical controls, van den Brand JASN 2014).

Conclusion

Overall, this strategy shortens the duration of Cyc therapy, maintaining remission rates. The relapse rate however is increased. Still, 70 % of patients remain in remission beyond two years after start of therapy (Figure 1).

Funding

  • Government Support - Non-U.S.