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Abstract: PO1898

Long-Term Outcomes of Tacrolimus Treatment for Idiopathic Membranous Nephropathy

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Nikolopoulou, Aikaterini K., Imperial College Healthcare NHS Trust, London, London, United Kingdom
  • Gleeson, Sarah, Imperial College Healthcare NHS Trust, London, London, United Kingdom
  • Dattani, Rakesh, Imperial College Healthcare NHS Trust, London, London, United Kingdom
  • Condon, Marie B., Imperial College Healthcare NHS Trust, London, London, United Kingdom
  • Cairns, Tom, Imperial College Healthcare NHS Trust, London, London, United Kingdom
  • Levy, Jeremy B., Imperial College Healthcare NHS Trust, London, London, United Kingdom
  • Lightstone, Liz, Imperial College London Faculty of Medicine, London, London, United Kingdom
  • McAdoo, Stephen Paul, Imperial College Healthcare NHS Trust, London, London, United Kingdom
  • Tam, Frederick W.K., Imperial College London Faculty of Medicine, London, London, United Kingdom
  • Pusey, Charles D., Imperial College London Faculty of Medicine, London, London, United Kingdom
  • Griffith, Megan, Imperial College Healthcare NHS Trust, London, London, United Kingdom
Background

Tacrolimus (TAC) is effective for the treatment of membranous nephropathy (MN).

Methods

Retrospective study of longterm outcomes of 111 patients (pts) with MN treated with TAC from January 2000 to June 2018.

Results

Demographics:table 1.
Treatment: 91/111 TAC monotherapy, 20/111 dual therapy with mycophenolate + TAC. All pretreated with ACEi/ARB.
Median follow up (FU) 68 months (IQR 33-115).
93/111 pts (84%) reached Partial Remission (uPCR reduction by 50% and <300mg/mmol) at 5.1 months (median,IQR 2-11).
76/111 (69%) also reached Complete Remission (uPCR<50mg/mmol ) at 15.2 months ( 9.3-24).
18/111(16%) did not respond to initial treatment with TAC.3/18 progressed to ESRD rapidly, 9/18 were treated with Rituximab (RTX), 4/18 with cyclophosphamide (CYP) and steroids. Only 4 achieved remission, all in the RTX group. 2 lost to FU.
48/93 (51%) of pts that achieved remission relapsed after 22 months (14-34) (Figure 1) following withdrawal or reduction of immunosuppresion. 28/48 were retreated with TAC and all achieved remission, 15/48 treated with RTX, remission in 11/15. 3/48 treated with CYP and steroids (2/3 remission,1 lost to FU). No treatment in 2.
11/28 cases retreated with tacrolimus had a second relapse.
At 3 months on TAC there was a reduction of eGFR from baseline (90ml/min) to 78 ml/min (48-99, p<0.001),(Figure 2).Renal function stabilised thereafter during the follow up period to 10 years. 10(9%) pts reached ESRD and 5/10 within 12 months from diagnosis;these pts had a lower baseline eGFR 48ml/min ( 23-61).

Conclusion

TAC can be an effective treatment for MN with a relatively rapid response. Lack of response to TAC and low eGFR at presentation are associated with non-response to alternative immunosuppression and ESRD. Relapse is common often necessitating repeat immunosuppression. Most pts maintain eGFR in the longterm.

Table 1. Demographics. Figure 1. Time from remission to relapse. Figure 2. A. eGFR and B. anti-PLA2R levels over time

Funding

  • Clinical Revenue Support