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Abstract: FR-PO859

Substitution of Oral for Intravenous Cyclophosphamide in Membranous Nephropathy

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Luzardo, Leonella, Hospital de Clínicas Facultad de Medicina UDELAR, Montevideo, Uruguay
  • Ottati, Gabriela, Universidad de la Republica, Montevideo, Uruguay
  • Cabrera, Jimena, Programa de Prevencion y tratamiento de las glomerulopatias, Montevideo, Uruguay
  • Garau, Mariela, Facultad de Medicina, UDELAR, Montevideo, Uruguay
  • Gonzalez-Bedat, Maria Carlota, Uruguayan Dialysis Registry, Montevideo, Uruguay
  • Coitiño rosa, Ruben Javier, Hospital de Clinicas, Montevideo, Uruguay
  • Auchayna, Maria, Pathology Department, Hospital de Clinicas, Universidad de la Republica, Montevideo, Uruguay
  • Santiago, José, Hospital de Clínicas Facultad de Medicina UDELAR, Montevideo, Uruguay
  • Silvariño, Ricardo, Hospital de Clínicas Facultad de Medicina UDELAR, Montevideo, Uruguay
  • Ferreiro, Alejandro, School of Medicine, Montevideo, Uruguay
  • Gadola, Liliana, Fisiopatología Hospital de Clínicas, Montevideo, Uruguay
  • Caorsi, Hena Maria, SUN, Montevideo, Uruguay
  • Noboa, Oscar A., Hospital de Clínicas Facultad de Medicina UDELAR, Montevideo, Uruguay
Background

Optimal treatment for idiopathic membranous nephropathy (MN) is s till a matter of controversy. Current guidelines recommend oral cyclophosphamide combined with steroids, but concerns about the cumulative toxicity of oral cyclophosphamide persist. During the last 30 years, MN has been treated with steroids plus a low-dose intravenous (IV) cyclophosphamide-based regimen in Uruguay. The aim of the study was to assess the efficacy of this regimen to induce remission in MN.

Methods

We performed a retrospective analysis of patients with membranous nephropathy, treated with a 6-month course of alternating monthly steroids (months 1, 3 and 5) plus IV cyclophosphamide (a single dose of 15 mg/kg IV the first day of months 2, 4, and 6).

Results

55 patients treated between 1990 and 2017 were included; the median age was 53 years (IQR=38–64) and 69% of the patients were men. The follow-up was 7.1 years (3.2–13.9). Forty two (76.4%) patients achieved remission, 24 (43.6%) complete and 18 (32.7%) partial, respectively. Thirteen patients (23.6%) remained nephrotic. Time to achieve partial remission after treatment was 5.9 (4.6–16.0) and 11.5 (5.9–15.0) months to achieve complete remission (Table 1). During the follow up, six (10.9%) patients (one with partial and five with no remission) required chronic renal replacement treatment (Figure 1). The latency between diagnosis and end stage renal disease was 3.5 years (2.3–10.1).

Conclusion

Monthly IV cyclophosphamide plus steroids is an effective and safe treatment for membranous nephropathy and is worthwhile to be considered in prospective clinical trials.