AUTHOR=Xing Hui-Lin , Ma Dong-Hong , Li Jin , Xu Qing-Yu , Ji Li-Ke , Zhu Qiong-Jie , Luo Yu-Qing , Guo Ming-Hao 

TITLE=Comparison of the efficacy of steroid-free versus classic steroid-containing regimens in primary membranous nephropathy

JOURNAL=Frontiers in Pharmacology

VOLUME=15

YEAR=2024

URL=https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2024.1286422

DOI=10.3389/fphar.2024.1286422

ISSN=1663-9812

ABSTRACT=<p><bold>Objective:</bold> To compare the efficacy of a steroid-free regimen with steroid-based treatment in managing primary membranous nephropathy (PMN) and investigate the potential benefits of steroid-free regimens in PMN therapy.</p><p><bold>Methods:</bold> This was a single-centre prospective cohort study. A total of 81 patients were divided into two groups according to their medication regimen: a rituximab (RTX)/tacrolimus (TAC) group (low-dose RTX combined with low-dose TAC group, without steroids, n = 31) and a prednisone (P)/TAC group (P combined with TAC group, n = 61). The changes in 24-h urine protein quantification, levels of blood albumin, blood creatinine, total cholesterol, triglyceride and fasting blood glucose as well as anti-phospholipase A2 receptor antibody titres were observed in both groups before treatment and after 1, 3, 6 and 12 months of treatment. Clinical remission (complete and partial remission), serological remission and recurrence were assessed in both groups after treatment, and the occurrence of adverse reactions was observed.</p><p><bold>Results:</bold> 1) Before treatment, there was no significant difference in baseline values between the two groups (<italic>p</italic> &gt; 0.05). 2) After 12 months of treatment, the 24-h proteinuria and total cholesterol levels in the RTX/TAC group were significantly lower than those in the P/TAC group (<italic>p</italic> &lt; 0.05). 3) After 6 months of treatment, the clinical remission rate of the RTX/TAC group was significantly higher than that of the P/TAC group (<italic>p</italic> &lt; 0.05). After 12 months of treatment, the clinical remission rate of the RTX/TAC group was significantly higher than that of the P/TAC group (<italic>p</italic> &lt; 0.05). (4) After 3, 6 and 12 months of treatment, serological remission rates in the RTX/TAC group were significantly higher than those in the P/TAC group (<italic>p</italic> &lt; 0.05). During treatment, the anti-PLA2R antibody titres in the RTX/TAC group remained lower than those in the P/TAC group (<italic>p</italic> &lt; 0.05).</p><p><bold>Conclusion:</bold> The low-dose RTX combined with low-dose TAC steroid-free regimen induces serological remission in patients with PMN earlier than the classic regimen of P combined with TAC, and there was no significant difference in adverse effects between the two groups. Besides, the long-term clinical remission effect of low-dose RTX combined with low-dose TAC is better than that of P combined with TAC.</p>