Comparative analysis of the efficacy of different treatments for idiopathic membranous nephropathy: a retrospectively real-world study

Abstract

Background

This study aimed to explore the clinical efficacy of different treatment regimens for idiopathic membranous nephropathy (IMN).

Methods

Patients with IMN were retrospectively analyzed by dividing into two groups: glucocorticoids combined with cyclophosphamide group (GC + CYC) and glucocorticoids combined with calcineurin inhibitor group (GC + CNIs). After 1 year of treatment, those who found that the initial treatment was not effective were switched to another regimen. Patients continued to be followed up for at least 1 year to observe the treatment effects of different treatment regimens.

Results

This study found that the rate of complete and partial remission (CR + PR) in the GC + CYC and GC + CNIs groups was 76.19 vs. 82.63% after 1 year of follow-up (p > .05). In the GC + CYC and GC + CNIs groups, 27.78 and 11.95% of the patients switched treatment regimens, respectively. After 2 years of follow-up, the CR + PR rate was significantly higher in the change to GC + CNIs group after the switch compared to before the switch (80.00 vs. 31.43%, p < .001). It was also significantly higher in the change to GC + CYC group compared to before the switch (68.42 vs. 31.58%, p = .023). The recurrence rate was significantly higher in the maintain GC + CNIs and change to GC + CNIs groups than in the maintain GC + CYC and change to GC + CYC groups (25.14 vs 6.36%, p < .001). The disengagement rate from immunotherapy was significantly higher in the maintain GC + CYC group and the change to GC + CYC group than in the maintain GC + CNIs group and the change to GC + CNIs group (76.36% vs 29.71%, p < .001). High titer of anti-phospholipase A2 receptor (anti-PLA2R) antibody (95%CI: 0.199–0.947, p = .036) and serum C3 (95%CI: 0.030–0.570, p = .007) were independent risk factors, while serum IgG (95%CI: 1.000–1.331, p = .050) was a favorable factor for achieving CR. Anti-PLA2R antibody was the independent risk factor that affected the worse renal condition (p = .023).

Conclusions

Timely change of treatment regimen can significantly enhance therapeutic effect. Compared with patients administered with CYC, those administered with CNIs were less likely to leave treatment and had a higher recurrence rate.

Keywords:

• Idiopathic membranous nephropathy
• treatment options
• clinical efficacy
• real world

Transparency

Declaration of funding

This study was supported by grants from the Primary Research & Development Plan of Shandong Province [2018GSF118227], the Science and Technology Plan (673 and 741) of Shizhong District of Jinan City, Clinical Medical Science and Technology Development Plan of Jinan City, Shandong Province [202019186], Horizontal issues of Shandong University [6020121011] and Shandong Natural Science Foundation (General Program) [ZR2022MH322]. The funders had no role in the design, data collection, analysis, interpretation, writing, or the decision of submission.

Declaration of financial/other relationships

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

Mengyao Sun: Conceived and designed the experiments, performed the experiments, analyzed the data, prepared figures and/or tables, authored or reviewed drafts of the paper, and approved the final draft. Jing Huang, Jianwei Dong: Performed the experiments, prepared figures and/or tables. Chaofan Li, Zhuo Li, Shasha Zhang: Performed the experiments, authored or reviewed drafts of the paper, and approved the final draft. Bing Chen: Conceived and designed the experiments, performed the experiments, analyzed the data, prepared figures and/or tables, authored or reviewed drafts of the paper, and approved the final draft. All authors read and approved the final manuscript.

Acknowledgements

None.