New research was presented at Kidney Week 2020 Reimagined, the virtual annual meeting of the American Society of Nephrology.
Guidelines recommend a cyclical corticosteroid-cyclophosphamide regimen for patients with primary membranous nephropathy (PMN) who are at high risk for progression. Although rituximab monotherapy and calcineurin inhibitors have been shown to be efficacious in inducing remission in this patient population, studies indicate that relapses are common following calcineurin inhibitor discontinuation. For a randomized, open-label controlled trial, patients with PMN and persistent nephrotic syndrome following a 6-month observation period were assigned to 6 months of cyclical treatment with a corticosteroid and cyclophosphamide or sequential treatment with tacrolimus (full dose for 6 months and tapered for another 3 months) and rituximab (1 g at month 6). Complete or partial remission of nephrotic syndrome at 24 months occurred in 84% of those in the corticosteroid-cyclophosphamide group, compared with 58% of those in the tacrolimus-rituximab group. Complete remission at 24 months occurred in 60% of the corticosteroid-cyclophosphamide group versus 26% of the tacrolimus-rituximab group. Immunological response was faster in the corticosteroid-cyclophosphamide group and associated with remission at 24 months. Relapse occurred in 2.7% of the corticosteroid-cyclophosphamide group and 12% in the tacrolimus-rituximab group, whereas serious adverse events were similar in both groups.