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The following is a summary of “Observational study of immunosuppressive treatment patterns and outcomes in primary membranous nephropathy: a multicenter retrospective analysis,” published in the October 2024 issue of Nephrology by Artan et al.
Researchers conducted a retrospective study to assess the efficacy of various immunosuppressive regimens in a large national cohort of patients with primary membranous nephropathy.
They included 558 patients from 47 centers who received at least 1 immunosuppressive agent with adequate follow-up data. The primary outcome was defined as complete (CR) or partial remission (PR), while the secondary outcome comprised at least a 50% reduction in estimated glomerular filtration rate (eGFR), initiation of kidney replacement therapies, development of stage 5 chronic kidney disease, or death.
The results showed a median age at diagnosis of 48 (IQR: 37–57) years, with 358 (64.2%) male patients followed for a median of 24 (IQR: 12–60) months. The most frequently used regimen was calcineurin inhibitors (CNIs) alone or with glucocorticoids (43.4%), followed by glucocorticoids with cyclophosphamide (GC-CYC) (39.6%), glucocorticoid monotherapy (25.8%), and rituximab (RTX) (9.1%). The overall remission rate was 66.1% (CR 26.7%, PR 39.4%), with 59 (10.6%) patients achieving the secondary composite outcome. The multivariate logistic regression revealed 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 RTX use (OR 0.296, 95% CI: 0.157–0.557, P<0.001) correlated with remission rates. In contrast, lower baseline hemoglobin was associated with the secondary composite outcome (OR: 0.843, 95% CI: 0.71
5–0.993, P=0.041) and CYC use correlated with higher remission rates (OR 1.534, 95% CI: 1.027–2.290, P=0.036).
Investigators concluded that higher baseline eGFR and serum albumin levels were linked to increased remission rates, while RTX treatment was associated with lower rates compared to GC-CYC. Caution was warranted in interpreting these results due to the study’s retrospective design.
Source: bmcnephrol.biomedcentral.com/articles/10.1186/s12882-024-03784-8#Abs1