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Abstract: SA-PO678

Reduced Dose Non-Cyclical Oral Cyclophosphamide and Prednisolone for Membranous Nephropathy

Session Information

Category: Glomerular Diseases

  • 1303 Glomerular Diseases: Clinical‚ Outcomes‚ and Trials

Authors

  • Subramaniam, Karppagavalli, KMCH, Coimbatore, Tamilnadu, India
  • Ponnusamy, Srimathi, KMCH, Coimbatore, Tamilnadu, India
  • Veerasamy, Mangalakumar, KMCH, Coimbatore, Tamilnadu, India
Background

Calcineurin inhibitors, rituximab and cyclic steroid & cyclophosphamide are the main therapeutic options in membranous nephropathy (MN). We describe the effect of non-cyclical reduced dose oral cyclophosphamide/ prednisolone (nCCP) in this group.

Methods

Patients were given oral cyclophosphamide (1.5mg/kg body weight/day) and prednisolone (0.5mg/kg body weight/day) for 3 months. At 3 months cyclophosphamide was stopped and prednisolone was tapered over the ensuing 4-7 weeks at a decremental rate of 5mg/week.

Results

Patient characteristics are described in table 1. Remission rates are given in figure 1 . 3 patients experienced major adverse events (pneumonia -2, zoster-1, hemorrhagic cystitis-1).

Conclusion

nCCP regime appears to have comparable effect in inducing proteinuria remission at 6 & 12 months in this retrospective study and it was achieved using lower dose of cyclophosphamide. The latter may help to reduce cumulative cyclophosphamide related toxicities. This regime avoids pulse steroid infusion without losing the efficacy. Corticosteroid and cyclophosphamide were used simultaneously and whether this could help to use lower doses of cyclophosphamide merits further evaluation. Despite using lower dose of cyclophosphamide (1.5mg/kg as opposed to 2mg/kg in RI-CYCLO study) 1 of our patients developed hemorrhagic cystitis raises the important safety question about the use of cytotoxic agents.

Patient characteristics (Total no = 21)
Age in years, mean (SD)43.7(11)
Sex - Male, n (%)12(57)
DM, n (%)2(9.5%)
HT, n (%)11(52)
Weight (kg), mean (SD)66.8(10.7)
Systolic BP (mmHg), mean (SD)127.8(16)
Diastolic BP (mmHg), mean (SD)76.6(8)
Serum creatinine (mg/dL), mean (SD0.7(0.23)
Urine protein/creatinine ratio, mean (SD)7(3.4)
Serum albumin (g/dL), mean (SD)2.2(0.5)
Total cholesterol (mg/dL), mean (SD)316(95)
Serum anti-PLA2R antibody positivity, n(%)14(66.7)