Cyclophosphamide induced early remission and was superior to rituximab in idiopathic membranous nephropathy patients with high anti-PLA2R antibody levels

BMC Nephrology

Research

Jian Wang¹  Liming Zhang²  Congdie Liang²  Jinyan Pan³  Cheng Xue⁴  Linlin Cui⁴  Bing Dai⁴  Jun Wu⁴  Shuwei Song⁴  Yawei Liu⁵  Chenchen Zhou⁶ 

[1] Department of Nephrology, No. 2 People’s Hospital of Fuyang City, Fuyang, 236000, Anhui Province, China;Department of Nephrology, Zhabei Central Hospital of Jing’an District, Shanghai, China;Department of Outpatient, Jinling Hospital, Nanjing, China;Division of Nephrology, Kidney Institute of CPLA, Shanghai Changzheng Hospital, Second Military Medical University (Navy Medical University), [e-mail], 415 Fengyang Road, 200000, Shanghai, China;Division of Nephrology, Kidney Institute of CPLA, Shanghai Changzheng Hospital, Second Military Medical University (Navy Medical University), [e-mail], 415 Fengyang Road, 200000, Shanghai, China;Department of Internal Medicine, Changzheng Hospital, Second Military Medical University, Shanghai, China;Division of Nephrology, Kidney Institute of CPLA, Shanghai Changzheng Hospital, Second Military Medical University (Navy Medical University), [e-mail], 415 Fengyang Road, 200000, Shanghai, China;Outpatient Department, Yangpu Third Military Retreat, Shanghai, China;

关键词: Rituximab;    Membranous nephropathy;    Cyclophosphamide;    Meta-analysis;    Treatment;   

DOI  :  10.1186/s12882-023-03307-x

 received in 2022-11-21, accepted in 2023-08-22,  发布年份 2023

来源: Springer

【 摘 要 】

Rituximab (RTX) and cyclophosphamide (CYC) based treatments are both recommended as first-line therapies in idiopathic membranous nephropathy (IMN) by KDIGO 2021 guideline. However, the efficacy of RTX vs. CYC-based treatments in IMN is still controversial. We performed this systemic review and meta-analysis registered in PROSPERO (CRD 42,022,355,717) by pooling data from randomized controlled trials or cohort studies in IMN patients using the EMBASE, PubMed, and Cochrane libraries (till Orc 1, 2022). The primary outcomes were the complete remission (CR) rate + partial remission (PR) rate. CR rate, immunologic response rate, relapse rate, and the risk of serious adverse events (SAE) were secondary outcomes. Eight studies involving 600 adult patients with IMN were included with a median follow-up duration of 12 to 60 months. RTX induced a similar overall remission rate compared with CYC (RR 0.88, 95% CI: 0.71, 1.09, P = 0.23). At the follow-up time of 6 months, RTX was associated with a lower CR + PR rate compared with CYC (RR 0.67, 95% CI: 0.52, 0.88, P = 0.003). Moreover, RTX might be less effective in inducing CR + PR than CYC treatment in IMN patients with high antiPLA2R antibody levels (RR 0.67, 95% CI: 0.48, 0.94, P = 0.02). The occurrences of CRs, relapse rates, immunologic response rates, and SAE were not significantly different between RTX and CYC, respectively. In conclusion, although the long-term efficacy and safety of CYC compared to RTX were comparable, CYC might respond faster and be more advantageous in IMN patients with high antiPLA2R antibody titers.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

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