ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: TH-PO1020

Five-Year Outcomes of Idiopathic Membranous Nephropathy and Nephrotic Syndrome After a Combination Treatment with Mizoribine and Low-Dose Prednisone

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Matsumoto, Yoshihiro, Shizuoka City Hospital, Shizuoka, Japan
  • Shimada, Yasushi, Shizuoka City Hospital, Shizuoka, Japan
  • Nojima, Youichi, Shizuoka City Hospital, Shizuoka, Japan
  • Iguchi, Koichiro, Shizuoka City Hospital, Shizuoka, Japan
  • Mori, Yasuo, Shibukawa Clinic, Shizuoka, Japan
Background

Patients with idiopathic membranous nephropathy (IMN) showing persistent high-grade proteinuria have the highest risk for developing end-stage renal failure. We previously reported the favorable short-term outcomes of treatment with mizoribine followed by low-dose prednisone. The purpose of the present study was to assess the long-term efficiency of this combined treatment in a larger number of patients.

Methods

Between 2004 and 2014, 22 patients with IMN and nephrotic-range proteinuria were administered the combined treatment. Mizoribine was initiated at a dose of 150 mg/day; after 1–3 months, 20 mg/day prednisone was added. The dosage of prednisone or mizoribine was tapered according to the urinary protein-to-creatinine ratio (P/C). For some of the patients who experienced side effects, relapse, or no response (NR), other immunosuppressive regimens were substituted. We evaluated patient outcomes for up to 5 years after initiating the combination therapy. The statuses of patients who were not followed up after the achievement of complete remission (CR), defined as a decrease in urinary P/C to <0.5, were assessed through a follow-up interview

Results

Before treatment, patient urinary P/C ranged from 3.7 to 15.9 g/g. At 1, 2, and 3 years after combination therapy, 68%, 77%, and 77% of patients attained CR, respectively. The 5-year actual rates for CR, partial remission, NR, two-fold Cr increase, and death were 82%, 14%, 5%, 5%, and 0%, respectively. Sixteen patients (73%) stopped treatment after 9–53 months of combination therapy. In patients who achieved at least one CR, the 3-year actual risk of relapse was 11%. Side effects, including fracture, were observed in four patients.

Conclusion

The addition of prednisone after mizoribine monotherapy resulted in fast and safe remission in a high proportion of patients with IMN and nephrotic syndrome. The risks associated with immunotherapy might be decreased by the initial prescription of mizoribine alone, which may act as a base for establishing therapy, followed by low-dose prednisone treatment.