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Abstract: TH-PO1017

Response to Therapy Is Poor in Anti-PLA2R Positive Idiopathic Membranous Nephropathy Patients as Compared to Anti-PLA2R Negative Patients

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Prasad, Narayan, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
  • Jaiswal, Akhilesh, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
  • Singh, Harshit, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
  • Agarwal, Vikas, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
Background

Idiopathic membranous nephropathy (IMN) is associated with Anti-PLA2R antibody expression on podocytes. We aimed to decipher the efficacy of tacrolimus (Tac) plus prednisolone, changes in anti-PLA2R level and differences in response to therapy in anti-PLA2R+ve and -ve patients.

Methods

In the study, total 101 (77 IMN and 24 seconday MN) patients were included. All secondary MN (15 diabetic, 7 lupus, 1 HBV and 1 collagen disease) were excluded. All IMN(n=77) patients were treated with combination of prednisolone (1mg/kg alternate day) and Tac 0.1mg/kg/day (target trough 6-10 ng/ml first 6 months(M) and 4-6 ng/ml for next 3M and then tapering by 1/3 each months to stop at 12M. Anti-PLA2R level was estimated at baseline, 3M, 6M,12M and end of follow-up (13 to 55 , median 36 months). Total remission,complete(CR) and partial (PR), relapse and side-effects were recorded and compared between Anti-PLA2R +ve and -ve groups.

Results

Of the 77 patients, at 3M 60(77.92%) CR-37, PR-23 ; 6M 61(79.22%) CR-53, PR-8; at12M 53(68.86%) CR-47, PR-6 achieved remission. Eight (10.38%) relapsed during tapering and 16(20.77%) showed no response at 12M. At the end, 68.51% remained in remission and 31.48% relapsed.
Out of 77 patients, 51 (66.3%) were anti-PLA2R +ve. Remission rate was lower in anti-PLA2R+ve than -ve (36/51 vs 24/26; p=0.03) at 3M; (36/51 vs 25/26; p=0.009) at 6M; and (31/51 vs 22/26; p=0.03) at 12M. PLA2R level was decreased by 60.38% and 77.56% at 3M and 6M respectively. Relapse rate was higher in anti-PlA2R +ve than−ve patients(P=0.02).There was significant correlations between PLA2R level and 24h proteinuria at baseline (r=0.72), 3M(r=0.81) and 6M(r=0.76).
During therapy 4 patients develop new diabetes, 4 cutaneous tinea, 1 osteonecrosis of femur head, 1 carpal tunnel syndrome, 3 tremor and 10 upper GI symptoms. eGFR decreased significantly (p=0.003) by 26.5% at end, which normalized after stopping Tac. Five non-responsive patients had doubled of serum creatinine and progressively deteriorated eGFR. To note, 4 females had succesful pregnancy and delivery, of them one had relapse after delivery.

Conclusion

Anti-PLA2R+ve IMN patients had poor response and more relapses as compared to PLA2R-ve patients. Remission with Tac and pred therapy is comparable to historical Ponticelli regimen with lesser side effects.

Funding

  • Government Support - Non-U.S.