Evaluating tacrolimus treatment in idiopathic membranous nephropathy in a cohort of 408 patients.
Evaluating tacrolimus treatment in idiopathic membranous nephropathy in a cohort of 408 patients.
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在 408 名患者的队列中评估他克莫司治疗特发性膜性肾病的效果
DOI：
10.1186/s12882-016-0427-z
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发表时间：
2017-01-05
期刊：
影响因子：
2.3
通讯作者：
Le WB
中科院分区：
文献类型：
--
作者：
Qin HZ;Liu L;Liang SS;Shi JS;Zheng CX;Hou Q;Lu YH;Le WB
背景KDIGO肾小球肾炎临床实践指南推荐他克莫司作为特发性膜性肾病（IMN）初始治疗的替代方案，然而评价他克莫司治疗IMN的大型观察性研究尚不多见。结果他克莫司治疗后6、12和24个月的累积部分或完全缓解率分别为50%、63%和67%，累积完全缓解率分别为4%、13%和23%。多变量logistic分析显示，诱导治疗期间他克莫司暴露量较高、女性、eGFR较高和既往无免疫抑制治疗史与缓解概率较高独立相关。部分或完全缓解的271例患者中有101例（37.3%）复发，完全缓解的95例患者中有18例（18.9%）复发。他克莫司减量治疗时间和完全缓解与部分缓解状态是与复发风险相关的独立因素。eGFR下降是他克莫司治疗期间最常见的不良事件。在他克莫司治疗期间，43例（10.5%）患者eGFR下降≥40%。结论小剂量他克莫司治疗IMN有效，总缓解率为66%，但复发率较高。然而，他克莫司治疗的安全性需要在大型随机临床试验中进一步验证。
BackgroundThe KDIGO Clinical Practice Guidelines for Glomerulonephritis recommended tacrolimus as an alternative regimen for the initial therapy for Idiopathic membranous nephropathy (IMN), however, large observational studies evaluating tacrolimus treatment in IMN remains rare.MethodsA total of 408 consecutive IMN patients with nephrotic syndrome who were treated with tacrolimus in Jinling Hospital were included. The effectiveness and safety of tacrolimus treatment in IMN were analyzed in this study.ResultsThe cumulative partial or complete remission after tacrolimus therapy were 50%, 63% and 67% at 6, 12 and 24 months, respectively, and the cumulative complete remission rates were 4%, 13% and 23%, respectively. Multivariate logistic analysis showed that higher tacrolimus exposure during induction treatment, female gender, higher eGFR and no history of previous immunosuppressive therapy were independently associated with higher probability of remission. A relapse occurred in 101 of the 271 (37.3%) patients with partial or complete remission, and 18 of the 95 (18.9%) patients with complete remission. Tapering duration of tacrolimus and complete remission versus partial remission status were independent factors associated with risk of relapse. A decline in eGFR was the most frequent adverse event during tacrolimus treatment. During tacrolimus treatment, a ≥40% decrease in eGFR was observed in 43 (10.5%) patients.ConclusionsLow dose tacrolimus is effective for IMN, with a total remission rate of 66% whereas with a rather high rate of relapse. However, the safety of tacrolimus treatment needs to be further validated in large randomized clinical trials.