Combination therapy with rituximab, low-dose cyclophosphamide, and prednisone for idiopathic membranous nephropathy: a case series.

Autor:	Cortazar, Frank B., Leaf, David E., Owens, Charles T., Laliberte, Karen, Pendergraft III, William F., Niles, John L., Pendergraft, William F 3rd
Předmět:	RITUXIMAB KIDNEY diseases CYCLOPHOSPHAMIDE ANTIRHEUMATIC agents IMMUNOSUPPRESSIVE agents ANTI-inflammatory agents COMBINATION drug therapy DOSE-effect relationship in pharmacology GLOMERULONEPHRITIS IMMUNOLOGICAL adjuvants LONGITUDINAL method ORAL drug administration PREDNISONE DIAGNOSIS
Zdroj:	BMC Nephrology; 2/1/2017, Vol. 18, p1-10, 10p
Abstrakt:	Background: Membranous nephropathy is a common cause of the nephrotic syndrome. Treatment with standard regimens fails to induce complete remission in most patients. We evaluated the efficacy of combination therapy with rituximab, low-dose, oral cyclophosphamide, and an accelerated prednisone taper (RCP) for the treatment of idiopathic membranous nephropathy.Methods: We analyzed 15 consecutive patients with idiopathic membranous nephropathy treated with RCP at Massachusetts General Hospital. Seven patients (47%) received RCP as initial therapy, and the other eight patients (53%) received RCP for relapsing or refractory disease. All patients had at least 1 year of follow-up. The co-primary outcomes were attainment of partial and complete remission. Partial remission was defined as a urinary protein to creatinine ratio (UPCR) < 3 g/g and a 50% reduction from baseline. Complete remission was defined as a UPCR < 0.3 g/g. Secondary outcomes were serious adverse events and the change in proteinuria, serum creatinine, serum albumin, cholesterol, triglycerides, and immunoglobulin G levels after 1 year of treatment.Results: Over a median follow-up time of 37 (IQR, 34-44) months, 100% of patients achieved partial remission and 93% of patients achieved complete remission at a median time of 2 and 13 months, respectively. After 1 year of treatment, median (IQR) UPCR declined from 8.2 (6.6-11.1) to 0.3 (0.2-0.7) g/g (P < 0.001). Three serious adverse events occurred over 51 patient years. No patients died or progressed to ESKD.Conclusions: Treatment of idiopathic membranous nephropathy with RCP resulted in high rates of complete remission. Larger studies evaluating this regimen are warranted. [ABSTRACT FROM AUTHOR]
Databáze:	Complementary Index
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