Immunosuppression for progressive membranous nephropathy: a UK randomised controlled trial

Area of Science:

• Nephrology
• Immunology
• Clinical Trials

Background:

• Idiopathic membranous nephropathy (IMN) frequently leads to end-stage renal disease.
• Limited trial evidence exists for immunosuppressive therapy in IMN patients with declining renal function.
• This study addresses the need for evidence-based treatment in this specific patient subset.

Purpose of the Study:

• To evaluate the efficacy of immunosuppression in preserving renal function in patients with IMN and declining excretory renal function.
• To compare supportive care alone versus immunosuppressive regimens (prednisolone/chlorambucil or ciclosporin).

Main Methods:

• A randomized controlled trial involving 108 patients across 37 UK renal units.
• Patients received supportive care alone, or supportive care plus 6 months of prednisolone/chlorambucil, or supportive care plus 12 months of ciclosporin.
• Primary outcome was a further 20% decline in renal function; intention-to-treat analysis was used.

Main Results:

• Prednisolone and chlorambucil significantly reduced the risk of a further 20% decline in renal function compared to supportive care (HR 0.44, p=0.0042).
• Ciclosporin did not show a significant benefit over supportive care alone (HR 1.17, p=0.54).
• Serious adverse events were higher in the prednisolone/chlorambucil group.

Conclusions:

• Six months of prednisolone and chlorambucil is the recommended treatment for IMN patients with deteriorating renal function.
• Ciclosporin should be avoided in this patient population.
• Further research may be needed to optimize treatment strategies and manage adverse events.