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Abstract: TH-PO705

Compressed and Concomitant Cyclophosphamide with Prednisone for Membranous Nephropathy: Low Doses for Very-High-Risk Patients

Session Information

Category: Glomerular Diseases

  • 1402 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Silverberg, Benjamin, University of Virginia, Charlottesville, Virginia, United States
  • Cavanaugh, Corey J., University of Virginia, Charlottesville, Virginia, United States
Introduction

Immunosuppressive therapy for primary membranous nephropathy (MN) has undergone significant change in the last 5 years. The "modified Ponticelli" regimen for MN is the recommended therapy for very high-risk MN according to KDIGO guidelines. The regimen consists of alternating cycles of cyclophosphamide and corticosteroids for a total of 6 months and comes with dose-dependent side effects such as cytopenias, infections, and malignancy. Here, we describe our experience with compressed and concomitant CYC/GC in very high-risk patients.

Case Description

We retrospectively analyzed 4 cases of PLA2R-positive membranous nephropathy with very high-risk features treated with concomitant prednisone 0.5mg/ kg tapered with oral cyclophosphamide 1.5-2mg/kg daily over 3-4 months. All patients were male between the ages 36-62. Clinical data, including serum PLA2R-AB levels and UPCR, were collected over the treatment period and 6 months after completion (Images 1 and 2). All patients had complete or partial remission at 9-12 months follow-up. No cytopenias or infections were observed. One patient developed steroid-related diabetes.

Discussion

Compared to the 24-week modified Ponticelli regimen, our doses of GC were lower, with a shorter duration of therapy and without any loss in efficacy (Table). A compressed and concomitant CYC/GC regimen in very high-risk patients with PLA2R membranous nephropathy is safe and effective in this limited case series.

 Compressed CYC/Pred Modified Ponticelli (for a 60kg patient)
Average total CYC dose11.21g10.8-13.5g
Average total GC dose1965mg11.4g
Total duration of therapy13.75 weeks24 weeks