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Abstract: FR-PO870

Efficacy of Cyclophosphamide in Association with Low-Dose Cyclosporine for the Treatment of High-Risk Primary Membranous Nephropathy

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Obrisca, Bogdan, Fundeni Clinical Institute, Bucharest, Romania
  • Jurubita, Roxana Adriana, Fundeni Clinical Institute, Bucharest, Romania
  • Sorohan, Bogdan Marian, Fundeni Clinical Institute, Bucharest, Romania
  • Andronesi, Andreea Gabriella, Fundeni Clinical Institute, Bucharest, Romania
  • Ismail, Gener, Fundeni Clinical Institute, Bucharest, Romania
Background

Ponticelli regimen is associated with the highest remission rate in the treatment of primary membranous nephropathy (pMN), but corticosteroids are associated important side effects. As such, we tested the efficacy of the combination of cyclophosphamide and low-dose cyclosporine in the management of high-risk pMN.

Methods

We prospectively followed 8 patients with high-risk pMN, treated with cyclophosphamide (iv, 15 mg/kg/month, for 6 consecutive months) and cyclosporine 100 mg/d (for proteinuria control) (CF/Cyc regimen). We compared this cohort to 8 consecutive, prospectively followed patients with pMN treated with the Ponticelli regimen, with a similar risk. Clinical and laboratory data were collected at baseline and at 1, 3, 6, 12- and 15-months thereafter.

Results

The two cohorts had similar baseline characteristics, except for higher antibody titer and proteinuria for patients treated with CF/Cyc regimen. The Ponticelli cohort of patients had a mean age, serum albumin and eGFR of 50 ± 10 years, 2.7 ± 0.8 g/dl and 55 ± 26 ml/min/1.73m2, respectively, while the median proteinuria and anti-PLA2R-ab titer were 6.25 (5.25-11) g/day and 122.5 (71.5-211) UI/ml, respectively. By comparison, the CF/Cyc cohort had a mean age, serum albumin and eGFR of 50 ± 9 years, 2.5 ± 0.5 g/dl and 69 ± 30 ml/min/1.73m2, respectively (p=0.9, 0.4 and 0.3), while the median 24-hour proteinuria and anti-PLA2R-ab titer were 9.85 (7.15-13.15) g/day and 291.5 (100-571.75) UI/ml, respectively (p=0.1 and 0.06). CF/Cyc regimen was associated with a 70% and 90% decrease from baseline in mean proteinuria and anti-PLA2R-ab titer, as opposed to a 58% and 97% decrease from baseline following Ponticelli regimen (p=0.7 and 0.8, respectively). There was a 41% and 31% increase from baseline in mean serum albumin following CF/Cyc and Ponticelli regimen, respectively (p=0.9). Overall, the remission rate (CR and PR) was 62% and 50% in the CF/Cyc and Ponticelli cohort, respectively, while 50% of patients in both cohorts showed complete immunological remission by 6 months.

Conclusion

In our cohort of patients with high-risk pMN, treatment with cyclophosphamide and low-dose cyclosporine was as effective as the Ponticelli regimen in inducing disease remission and could represent an alternative to steroid-based regimens.