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Abstract: FR-PO876

Clinical Advantage of Mizoribine in Elderly Patients with Primary Membranous Nephropathy

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Hasegawa, Hajime, Study group for nephrotic syndrome in the elderly, Kawagoe, Japan
  • Yokoyama, Hitoshi, Study group for nephrotic syndrome in the elderly, Kawagoe, Japan
  • Yamagata, Kunihiro, Study group for nephrotic syndrome in the elderly, Kawagoe, Japan
  • Iwano, Masayuki, Study group for nephrotic syndrome in the elderly, Kawagoe, Japan
  • Akiyama, Shin'ichi, Study group for nephrotic syndrome in the elderly, Kawagoe, Japan
  • Takayanagi, Kaori, Study group for nephrotic syndrome in the elderly, Kawagoe, Japan
  • Iwashita, Takatsugu, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
  • Shimizu, Taisuke, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
  • Ogawa, Tomonari, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
  • Kanozawa, Koichi, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
Background

Membranous nephropathy (MN) is usually managed in Japan by sole administration of Prednisolone (PSL) of 1 mg/kg for 4 weeks, and concomitant use of immunosuppressant would be thereafter considered. Here, we show the clinical efficacy of concomitant use of lower doses of Mizoribine (MZB) and PSL in elderly patients with MN.

Methods

Thirty-six elderly patients (age≥65) diagnosed primary MN showing nephrotic syndrome were enrolled from 24 independent facilities. The patients were randomly assigned to two groups, solely administered PSL 30 mg (P group, n=18), or concomitantly administered MZB 150 mg (MP group, n=18), and observed for 12 months. In some cases, anti-phospholipase A2 receptor antibody (PLA2R-Ab) titer was measured.

Results

Percent-urine protein-to-Cr ratio (PCR) comparing to baseline of MP was better than P (50.0% vs 55.6% at 3 M, 31.4% vs 39.9% at 6 M). Logistic analysis showed that the odds ratio of high responder (PCR<1.0 g/gCr at 3 M) in MP group was 1.50 (1.00 in P group), suggesting that the concomitant use of MZB might accelerate the remission. Total amount of administered PSL in MP group seemed to be less than that in P group. Kaplan-Meier analysis showed that time-course of complete-remission (PCR<0.3 g/gCr) ratio in MP group was significantly higher than P group studied by log-rank test (p=0.01) and generalized Wilcoxon test (p<0.01). In additional logistic analysis, the odds ratio of the high responder was 2.67 (MP) and 1.00 (P) in cases showing negative PLA2R-Ab whereas the odds ratio was 0.33 (MP) and 0.40 (P) in cases showing positive PLA2R Ab, suggesting that concomitant use of MZB might be more effective in PLA2R-Ab negative cases. Kaplan-Meier analysis also showed that time-course of remission (PCR<1.0 g/gCr) ratio in PLA2R negative group was higher than PLA2R positive group.

Conclusion

Concomitant use of low dose MZB and PSL at the start-up might be beneficial for elderly patients with MN. Qualitative measurement of PLA2R-Ab might be useful for the prediction of therapeutical response.