Steroid plus tacrolimus highly effective for Idiopathic Membranous Nephropathy regardless of proteinuria levels
China: In patients of Idiopathic Membranous Nephropathy with all degrees of proteinuria, a combo of steroids and tacrolimus showed significant efficacy in a recent study published in the International Journal of Clinical Practice. Rituximab (RTX), however, was found to be more effective in patients with moderate proteinuria and was safer in gastrointestinal symptoms and bone marrow suppression.
"This was the first network meta-analysis that compared the efficacy of ten idiopathic membranous nephropathy treatments in patients with different proteinuria, and also the first one reported the risks of IMN treatments in bone marrow suppression and gastrointestinal symptoms," the researchers wrote.
Previous studies have shown the variation in the efficacy of drugs in idiopathic membranous nephropathy (IMN) patients with moderate or high proteinuria. However, no systematic comparison has confirmed it. Therefore, Gaosi Xu, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China, and colleagues performed a network meta-analysis (NMA) to respectively compare the efficacy of ten IMN treatments in patients with moderate and high proteinuria and compare the risk of adverse events with 10 IMN regimens.
For this purpose, the researchers included randomized controlled trials (RCTs) and observational studies analyzing the main therapeutic regimens for IMN from some databases. To analyze the rates of total remission (TR), bone marrow suppression, and gastrointestinal symptoms, network comparisons were performed. The surface under the cumulative ranking area (SUCRA) was calculated to rank interventions.
Based on the study, the researchers found the following:
- Seventeen RCTs and eight observational studies involving 1778 patients were pooled for comparison of ten interventions.
- Steroid + tacrolimus (TAC) showed the highest probabilities of TR whether patients had severe proteinuria or not (SUCRA 89.5% and 88.9%, separately).
- Rituximab (RTX) was more beneficial for TR in patients with proteinuria <8 g/d (SUCRA 66.0%) and was associated with a lower risk of bone marrow suppression and gastrointestinal symptoms (SUCRA 21.7% and 21.4%, separately).
- TAC + RTX and steroids + cyclophosphamide induced the highest rates of bone marrow suppression (SUCRA 90.6% and 88.3%, separately) and gastrointestinal symptoms (SUCRA 86.0% and 72.1%, separately).
The researchers wrote in their study, "our results confirmed steroid + tacrolimus to be the most efficient therapy for total remission irrespective of patients' proteinuria levels."
"Rituximab was more effective in achieving total remission for patients with proteinuria <8 g/d. TAC + RTX and steroid + CYC had a similar risk of gastrointestinal symptoms and bone marrow suppression, which was significantly different from RTX."
The authors concluded, "for all of this, more RCTs are needed to consolidate our conclusions and investigate the curative efficacy of the implementation period and dosages on drug efficacy."
Reference:
Miaomiao Chen, Jiarong Liu, Yi Xiong, Gaosi Xu, "Treatment of Idiopathic Membranous Nephropathy for Moderate or Severe Proteinuria: A Systematic Review and Network Meta-Analysis", International Journal of Clinical Practice, vol. 2022, Article ID 4996239, 12 pages, 2022. https://doi.org/10.1155/2022/4996239
