Comparison Of Use Of Steroid Alone Or In Combination With Cyclophosphamide For The Initial Therapy Of Idiopathic Membranous Nephropathy

Objective: Idiopathic membranous nephropathy (IMN) is one of the major causes of adult-onset nephrotic syndrome. Despite treatment, approximately 30%-40% of the patients can develop end-stage renal disease (ESRD) within 10-15 years. The objective of this study is to evaluate the efficacy and safety of using oral steroid monotherapy and compare it with steroid and cyclophosphamide (CTX) combination treatment in patients with IMN.Methods: All native biopsies (n=509) performed at our center between 2006 and 2018 were retrospectively examined. In total, 83 (16.3%) patients were diagnosed with biopsy-proven IMN and 47 patients with IMN presented with nephrotic syndrome. Clinical remission and renal progressions of 20 patients receiving oral steroid monotherapy and 27 patients treated with oral steroid and CTX were evaluated.Results: All patients in the oral steroid-receiving group achieved remission [n=12, 60% complete; n=8, 40% partial remissions (PR)] as compared to the combination therapy-receiving group (n=9, 33.3%, complete; n=18, 66.7% PR). Steroid monotherapy and steroid + CTX-induced similar complete remission rates (60% vs 33.3%; p>0.05). Relapse occurred in 6 and 10 patients in the steroid-receiving group (30.0%) and the steroid + CTX-receiving group (37%), respectively (p>0.05). Proteinuria (g/day) at baseline, at six months, and at the end of the treatment were not different between the groups [7.58 +/- 4.10 vs 8.74 +/- 4.02, p=0.34 (baseline); 1,452 +/- 1,579 vs 2,682 +/- 2,730, p=0.059 (six months); 362 +/- 416 vs. 220 +/- 274, p=0.115 (at the end of treatment)].Conclusion: This study's results suggest that the application of oral steroid monotherapy can function as an alternative therapeutic regimen for patients with nephrotic IMN. The short-term efficiency and patient tolerability of both regimens were found to be acceptable. Further randomized controlled trials with more subjects are needed to clarify the exact benefits of oral steroid monotherapy in patients with IMN.