Observational study of immunosuppressive treatment patterns and outcomes in primary membranous nephropathy: a multicenter retrospective analysis

BMC Nephrol. 2024 Oct 1;25(1):327. doi: 10.1186/s12882-024-03784-8.

Abstract

Background: We evaluated the efficacy of different immunosuppressive regimens in patients with primary membranous nephropathy in a large national cohort.

Methods: In this registry study, 558 patients from 47 centers who were treated with at least one immunosuppressive agent and had adequate follow-up data were included. Primary outcome was defined as complete (CR) or partial remission (PR). Secondary composite outcome was at least a 50% reduction in estimated glomerular filtration (eGFR), initiation of kidney replacement therapies, development of stage 5 chronic kidney disease, or death.

Results: Median age at diagnosis was 48 (IQR: 37-57) years, and 358 (64.2%) were male. Patients were followed for a median of 24 (IQR: 12-60) months. Calcineurin inhibitors (CNIs) with or without glucocorticoids were the most commonly used regimen (43.4%), followed by glucocorticoids and cyclophosphamide (GC-CYC) (39.6%), glucocorticoid monotherapy (25.8%), and rituximab (RTX) (9.1%). Overall remission rate was 66.1% (CR 26.7%, PR 39.4%), and 59 (10.6%) patients reached secondary composite outcome. Multivariate logistic regression showed that baseline eGFR (OR 1.011, 95% CI: 1.003-1.019, p = 0.007), serum albumin (OR 1.682, 95% CI: 1.269-2.231, p < 0.001), and use of RTX (OR 0.296, 95% CI: 0.157-0.557, p < 0.001) were associated with remission rates; whereas only lower baseline hemoglobin was significantly associated with secondary composite outcome (OR: 0.843, 95% CI: 0.715-0.993, p = 0.041). CYC use was significantly associated with higher remission (OR 1.534, 95% CI: 1.027-2.290, p = 0.036).

Conclusions: Higher baseline eGFR and serum albumin levels correlated with increased remission rates. Remission rates were lower in patients treated with RTX, while those on GC-CYC showed higher rates of remission. Due to the study's retrospective nature and multiple treatments used, caution is warranted in interpreting these findings.

Keywords: Chronic kidney disease; Immunosuppression; Membranous nephropathy; Remission.

Publication types

  • Observational Study
  • Multicenter Study

MeSH terms

  • Adult
  • Calcineurin Inhibitors / therapeutic use
  • Cyclophosphamide / therapeutic use
  • Drug Therapy, Combination
  • Female
  • Glomerular Filtration Rate
  • Glomerulonephritis, Membranous* / drug therapy
  • Glucocorticoids / therapeutic use
  • Humans
  • Immunosuppressive Agents* / therapeutic use
  • Male
  • Middle Aged
  • Registries
  • Remission Induction
  • Retrospective Studies
  • Rituximab / therapeutic use
  • Treatment Outcome

Substances

  • Immunosuppressive Agents
  • Glucocorticoids
  • Rituximab
  • Calcineurin Inhibitors
  • Cyclophosphamide