Substitution of Oral for Intravenous Cyclophosphamide in Membranous Nephropathy.

Autor:	Luzardo L; Department of Nephrology, Clinic Hospital, University of the Republic, Montevideo, Uruguay.; Uruguayan Registry of Glomerulopathies, Montevideo, Uruguay., Ottati G; Department of Nephrology, Clinic Hospital, University of the Republic, Montevideo, Uruguay.; Uruguayan Registry of Glomerulopathies, Montevideo, Uruguay., Cabrera J; Uruguayan Registry of Glomerulopathies, Montevideo, Uruguay.; Department of Nephrology, Military Hospital, Montevideo, Uruguay., Trujillo H; Department of Nephrology, University Hospital 12 October, Madrid, Spain., Garau M; Uruguayan Registry of Glomerulopathies, Montevideo, Uruguay.; Department of Quantitative Methods, School of Medicine, University of the Republic, Montevideo, Uruguay., González Bedat C; Department of Nephrology, CASMU, Montevideo, Uruguay.; Uruguayan Dialysis Registry, Montevideo, Uruguay., Coitiño R; Department of Nephrology, Clinic Hospital, University of the Republic, Montevideo, Uruguay.; Uruguayan Registry of Glomerulopathies, Montevideo, Uruguay., Aunchayna MH; Uruguayan Registry of Glomerulopathies, Montevideo, Uruguay.; Department of Pathology, Clinic Hospital, School of Medicine, University of the Republic, Montevideo, Uruguay., Santiago J; Department of Nephrology, Clinic Hospital, University of the Republic, Montevideo, Uruguay.; Department of Nephrology, Médica Uruguaya, Montevideo, Uruguay., Baldovinos G; Uruguayan Registry of Glomerulopathies, Montevideo, Uruguay., Silvariño R; Department of Nephrology, Clinic Hospital, University of the Republic, Montevideo, Uruguay.; Uruguayan Registry of Glomerulopathies, Montevideo, Uruguay.; Department of Nephrology, COSEM, Montevideo, Uruguay., Ferreiro A; Department of Nephrology, Clinic Hospital, University of the Republic, Montevideo, Uruguay.; Department of Nephrology, CASMU, Montevideo, Uruguay., González-Martínez F; Department of Nephrology, Clinic Hospital, University of the Republic, Montevideo, Uruguay.; Uruguayan Registry of Glomerulopathies, Montevideo, Uruguay., Gadola L; Department of Nephrology, Clinic Hospital, University of the Republic, Montevideo, Uruguay.; Uruguayan Registry of Glomerulopathies, Montevideo, Uruguay.; Department of Nephrology, CASMU, Montevideo, Uruguay., Noboa O; Department of Nephrology, Clinic Hospital, University of the Republic, Montevideo, Uruguay.; Uruguayan Registry of Glomerulopathies, Montevideo, Uruguay., Caorsi H; Department of Nephrology, Clinic Hospital, University of the Republic, Montevideo, Uruguay.; Uruguayan Registry of Glomerulopathies, Montevideo, Uruguay.
Jazyk:	angličtina
Zdroj:	Kidney360 [Kidney360] 2020 Aug 07; Vol. 1 (9), pp. 943-949. Date of Electronic Publication: 2020 Aug 07 (Print Publication: 2020).
DOI:	10.34067/KID.0002802020
Abstrakt:	Background: Optimal immunosuppressive treatment for membranous nephropathy is still a matter of controversy. Current recommendations include oral cyclophosphamide combined with steroids (modified Ponticelli regimen) as first-line treatment in patients who are high risk. However, concerns about the cumulative toxicity of oral cyclophosphamide persist. In the last 30 years, a protocol based on low-dose intravenous cyclophosphamide plus steroids has been used to treat membranous nephropathy in Uruguay. We aimed to assess the efficacy of this regimen to induce clinical remission in patients with membranous nephropathy. Methods: In this retrospective, observational cohort study, we analyzed the outcome of 55 patients with membranous nephropathy treated between 1990 and 2017 with a 6-month course of alternating steroids (months 1, 3, and 5) plus intravenous cyclophosphamide (single dose of 15 mg/kg on the first day of months 2, 4, and 6). Results: At 24 months, 39 (71%) patients achieved clinical response with complete remission observed in 23 patients (42%) and partial remission in 16 (29%). Median time to achieve partial and complete remission was 5.9 and 11.5 months, respectively. Absence of response was observed in 16 patients (29%), five of whom started chronic RRT after a median follow-up of 3.5 years. Clinical relapse occurred in nine of 33 (27%) patients at a median of 34 months after treatment discontinuation. Conclusions: Replacement of oral cyclophosphamide with a single intravenous pulse on months 2, 4, and 6 of the modified Ponticelli regimen can be an effective and safe alternative for treatment of membranous nephropathy. Podcast: This article contains a podcast at https://www.asn-online.org/media/podcast/K360/2020_09_24_KID0002802020.mp3. Competing Interests: All authors have nothing to disclose. (Copyright © 2020 by the American Society of Nephrology.)
Databáze:	MEDLINE
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