Comparative analysis of the efficacy of different treatments for idiopathic membranous nephropathy: a retrospectively real-world study

BACKGROUND This study aimed to explore the clinical efficacy of different treatment regimens for idiopathic membranous nephropathy (IMN). METHODS Patients with IMN were retrospectively analyzed by dividing into two groups: glucocorticoids combined with cyclophosphamide group (GC + CYC) and glucocorticoids combined with calcineurin inhibitor group (GC + CNIs). After 1 year of treatment, those who found that the initial treatment was not effective were switched to another regimen. Patients continued to be followed up for at least 1 year to observe the treatment effects of different treatment regimens. RESULTS This study found that the rate of complete and partial remission (CR + PR) in the GC + CYC and GC + CNIs groups was 76.19% vs 82.63% after one year of follow-up (P > 0.05). In the GC + CYC and GC + CNIs groups, 27.78% and 11.95% of the patients switched treatment regimens, respectively. After two years of follow-up, the CR + PR rate was significantly higher in the change to GC + CNIs group after the switch compared to before the switch (80.00% vs 31.43%, P < 0.001). It was also significantly higher in the change to GC + CYC group compared to before the switch (68.42% vs 31.58%, P = 0.023). The recurrence rate was significantly higher in the maintain GC + CNIs and change to GC + CNIs groups than in the maintain GC + CYC and change to GC + CYC groups (25.14% vs 6.36%, P < 0.001). The disengagement rate from immunotherapy was significantly higher in the maintain GC + CYC group and the change to GC + CYC group than in the maintain GC + CNIs group and the change to GC + CNIs group (76.36% vs 28.00%, P < 0.001). High titer of anti-phospholipase A2 receptor (anti-PLA2R) antibody (95%CI: 0.199-0.947, P = 0.036) and serum C3 (95%CI: 0.030-0.570, P = 0.007) were independent risk factors, while serum IgG (95%CI: 1.000-1.331, P = 0.050) was a favorable factor for achieving CR. Anti-PLA2R antibody was the independent risk factor that affected the worse renal condition (P = 0.023). CONCLUSIONS Timely change of treatment regimen can significantly enhance therapeutic effect. Compared with patients administered with CYC, those administered with CNIs were less likely to leave treatment and had a higher recurrence rate.