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

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 one year of follow-up (P > 0.05). In the GC + CYC and GC + CNIs groups, 27.78% and 11.95% of the patients switched treatment regimens, respectively. After two 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 < 0.001). It was also significantly higher in the change to GC + CYC group compared to before the switch (68.42% vs 31.58%, P = 0.023). 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 < 0.001). 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 28.00%, P < 0.001). High titer of anti-phospholipase A2 receptor (anti-PLA2R) antibody (95%CI: 0.199-0.947, P = 0.036) and serum C3 (95%CI: 0.030-0.570, P = 0.007) were independent risk factors, while serum IgG (95%CI: 1.000-1.331, P = 0.050) was a favorable factor for achieving CR. Anti-PLA2R antibody was the independent risk factor that affected the worse renal condition (P = 0.023).

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.