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

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

Chronic kidney disease Immunosuppression Membranous nephropathy Remission

Journal

BMC nephrology

ISSN: 1471-2369

Titre abrégé: BMC Nephrol

Pays: England

ID NLM: 100967793

Informations de publication

Date de publication:
01 Oct 2024

Historique:

received: 08 04 2024

accepted: 27 09 2024

medline: 2 10 2024

pubmed: 2 10 2024

entrez: 1 10 2024

Statut: epublish

Résumé

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

Sections du résumé

BACKGROUND BACKGROUND

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

METHODS 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 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 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.

Identifiants

DOI: 10.1186/s12882-024-03784-8 PMID: 39354386

pubmed: 39354386

doi: 10.1186/s12882-024-03784-8

pii: 10.1186/s12882-024-03784-8

doi:

Substances chimiques

Immunosuppressive Agents 0

Glucocorticoids 0

Rituximab 4F4X42SYQ6

Calcineurin Inhibitors 0

Cyclophosphamide 8N3DW7272P

Types de publication

Journal Article Observational Study Multicenter Study

Langues

eng

Sous-ensembles de citation

Pagination

327

Informations de copyright

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