Combination therapy with rituximab, low-dose cyclophosphamide, and prednisone for idiopathic membranous nephropathy: a case series

Frank B. Cortazar, David E. Leaf, Charles T. Owens, Karen Laliberte, William F. Pendergraft, John L. Niles

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: Membranous nephropathy is a common cause of the nephrotic syndrome. Treatment with standard regimens fails to induce complete remission in most patients. We evaluated the efficacy of combination therapy with rituximab, low-dose, oral cyclophosphamide, and an accelerated prednisone taper (RCP) for the treatment of idiopathic membranous nephropathy. Methods: We analyzed 15 consecutive patients with idiopathic membranous nephropathy treated with RCP at Massachusetts General Hospital. Seven patients (47%) received RCP as initial therapy, and the other eight patients (53%) received RCP for relapsing or refractory disease. All patients had at least 1 year of follow-up. The co-primary outcomes were attainment of partial and complete remission. Partial remission was defined as a urinary protein to creatinine ratio (UPCR) < 3 g/g and a 50% reduction from baseline. Complete remission was defined as a UPCR < 0.3 g/g. Secondary outcomes were serious adverse events and the change in proteinuria, serum creatinine, serum albumin, cholesterol, triglycerides, and immunoglobulin G levels after 1 year of treatment. Results: Over a median follow-up time of 37 (IQR, 34-44) months, 100% of patients achieved partial remission and 93% of patients achieved complete remission at a median time of 2 and 13 months, respectively. After 1 year of treatment, median (IQR) UPCR declined from 8.2 (6.6-11.1) to 0.3 (0.2-0.7) g/g (P < 0.001). Three serious adverse events occurred over 51 patient years. No patients died or progressed to ESKD. Conclusions: Treatment of idiopathic membranous nephropathy with RCP resulted in high rates of complete remission. Larger studies evaluating this regimen are warranted.

Original languageEnglish (US)
Pages (from-to)1-10
Number of pages10
JournalBMC Nephrology
Volume18
Issue number1
DOIs
StatePublished - Feb 1 2017
Externally publishedYes

Fingerprint

Membranous Glomerulonephritis
Prednisone
Cyclophosphamide
Creatinine
Therapeutics
Rituximab
Proteins
Nephrotic Syndrome
Proteinuria
Serum Albumin
General Hospitals
Triglycerides
Immunoglobulin G
Cholesterol

Keywords

  • Cyclophosphamide
  • Membranous nephropathy
  • Remission
  • Rituximab

ASJC Scopus subject areas

  • Nephrology

Cite this

Combination therapy with rituximab, low-dose cyclophosphamide, and prednisone for idiopathic membranous nephropathy : a case series. / Cortazar, Frank B.; Leaf, David E.; Owens, Charles T.; Laliberte, Karen; Pendergraft, William F.; Niles, John L.

In: BMC Nephrology, Vol. 18, No. 1, 01.02.2017, p. 1-10.

Research output: Contribution to journalArticle

Cortazar, Frank B. ; Leaf, David E. ; Owens, Charles T. ; Laliberte, Karen ; Pendergraft, William F. ; Niles, John L. / Combination therapy with rituximab, low-dose cyclophosphamide, and prednisone for idiopathic membranous nephropathy : a case series. In: BMC Nephrology. 2017 ; Vol. 18, No. 1. pp. 1-10.
@article{58e3addc132e4310b7295bb40890bad6,
title = "Combination therapy with rituximab, low-dose cyclophosphamide, and prednisone for idiopathic membranous nephropathy: a case series",
abstract = "Background: Membranous nephropathy is a common cause of the nephrotic syndrome. Treatment with standard regimens fails to induce complete remission in most patients. We evaluated the efficacy of combination therapy with rituximab, low-dose, oral cyclophosphamide, and an accelerated prednisone taper (RCP) for the treatment of idiopathic membranous nephropathy. Methods: We analyzed 15 consecutive patients with idiopathic membranous nephropathy treated with RCP at Massachusetts General Hospital. Seven patients (47{\%}) received RCP as initial therapy, and the other eight patients (53{\%}) received RCP for relapsing or refractory disease. All patients had at least 1 year of follow-up. The co-primary outcomes were attainment of partial and complete remission. Partial remission was defined as a urinary protein to creatinine ratio (UPCR) < 3 g/g and a 50{\%} reduction from baseline. Complete remission was defined as a UPCR < 0.3 g/g. Secondary outcomes were serious adverse events and the change in proteinuria, serum creatinine, serum albumin, cholesterol, triglycerides, and immunoglobulin G levels after 1 year of treatment. Results: Over a median follow-up time of 37 (IQR, 34-44) months, 100{\%} of patients achieved partial remission and 93{\%} of patients achieved complete remission at a median time of 2 and 13 months, respectively. After 1 year of treatment, median (IQR) UPCR declined from 8.2 (6.6-11.1) to 0.3 (0.2-0.7) g/g (P < 0.001). Three serious adverse events occurred over 51 patient years. No patients died or progressed to ESKD. Conclusions: Treatment of idiopathic membranous nephropathy with RCP resulted in high rates of complete remission. Larger studies evaluating this regimen are warranted.",
keywords = "Cyclophosphamide, Membranous nephropathy, Remission, Rituximab",
author = "Cortazar, {Frank B.} and Leaf, {David E.} and Owens, {Charles T.} and Karen Laliberte and Pendergraft, {William F.} and Niles, {John L.}",
year = "2017",
month = "2",
day = "1",
doi = "10.1186/s12882-017-0459-z",
language = "English (US)",
volume = "18",
pages = "1--10",
journal = "BMC Nephrology",
issn = "1471-2369",
publisher = "BioMed Central",
number = "1",

}

TY - JOUR

T1 - Combination therapy with rituximab, low-dose cyclophosphamide, and prednisone for idiopathic membranous nephropathy

T2 - a case series

AU - Cortazar, Frank B.

AU - Leaf, David E.

AU - Owens, Charles T.

AU - Laliberte, Karen

AU - Pendergraft, William F.

AU - Niles, John L.

PY - 2017/2/1

Y1 - 2017/2/1

N2 - Background: Membranous nephropathy is a common cause of the nephrotic syndrome. Treatment with standard regimens fails to induce complete remission in most patients. We evaluated the efficacy of combination therapy with rituximab, low-dose, oral cyclophosphamide, and an accelerated prednisone taper (RCP) for the treatment of idiopathic membranous nephropathy. Methods: We analyzed 15 consecutive patients with idiopathic membranous nephropathy treated with RCP at Massachusetts General Hospital. Seven patients (47%) received RCP as initial therapy, and the other eight patients (53%) received RCP for relapsing or refractory disease. All patients had at least 1 year of follow-up. The co-primary outcomes were attainment of partial and complete remission. Partial remission was defined as a urinary protein to creatinine ratio (UPCR) < 3 g/g and a 50% reduction from baseline. Complete remission was defined as a UPCR < 0.3 g/g. Secondary outcomes were serious adverse events and the change in proteinuria, serum creatinine, serum albumin, cholesterol, triglycerides, and immunoglobulin G levels after 1 year of treatment. Results: Over a median follow-up time of 37 (IQR, 34-44) months, 100% of patients achieved partial remission and 93% of patients achieved complete remission at a median time of 2 and 13 months, respectively. After 1 year of treatment, median (IQR) UPCR declined from 8.2 (6.6-11.1) to 0.3 (0.2-0.7) g/g (P < 0.001). Three serious adverse events occurred over 51 patient years. No patients died or progressed to ESKD. Conclusions: Treatment of idiopathic membranous nephropathy with RCP resulted in high rates of complete remission. Larger studies evaluating this regimen are warranted.

AB - Background: Membranous nephropathy is a common cause of the nephrotic syndrome. Treatment with standard regimens fails to induce complete remission in most patients. We evaluated the efficacy of combination therapy with rituximab, low-dose, oral cyclophosphamide, and an accelerated prednisone taper (RCP) for the treatment of idiopathic membranous nephropathy. Methods: We analyzed 15 consecutive patients with idiopathic membranous nephropathy treated with RCP at Massachusetts General Hospital. Seven patients (47%) received RCP as initial therapy, and the other eight patients (53%) received RCP for relapsing or refractory disease. All patients had at least 1 year of follow-up. The co-primary outcomes were attainment of partial and complete remission. Partial remission was defined as a urinary protein to creatinine ratio (UPCR) < 3 g/g and a 50% reduction from baseline. Complete remission was defined as a UPCR < 0.3 g/g. Secondary outcomes were serious adverse events and the change in proteinuria, serum creatinine, serum albumin, cholesterol, triglycerides, and immunoglobulin G levels after 1 year of treatment. Results: Over a median follow-up time of 37 (IQR, 34-44) months, 100% of patients achieved partial remission and 93% of patients achieved complete remission at a median time of 2 and 13 months, respectively. After 1 year of treatment, median (IQR) UPCR declined from 8.2 (6.6-11.1) to 0.3 (0.2-0.7) g/g (P < 0.001). Three serious adverse events occurred over 51 patient years. No patients died or progressed to ESKD. Conclusions: Treatment of idiopathic membranous nephropathy with RCP resulted in high rates of complete remission. Larger studies evaluating this regimen are warranted.

KW - Cyclophosphamide

KW - Membranous nephropathy

KW - Remission

KW - Rituximab

UR - http://www.scopus.com/inward/record.url?scp=85011390784&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85011390784&partnerID=8YFLogxK

U2 - 10.1186/s12882-017-0459-z

DO - 10.1186/s12882-017-0459-z

M3 - Article

C2 - 28143416

AN - SCOPUS:85011390784

VL - 18

SP - 1

EP - 10

JO - BMC Nephrology

JF - BMC Nephrology

SN - 1471-2369

IS - 1

ER -