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Membranous glomerulopathy and treatment with Acthar®: a case study
1Nephrology/Hypertension Associates, Columbia, MO, USA.
Insights
H.P. Acthar Gel offers a potential new treatment for refractory membranous nephropathy. This therapy significantly reduced proteinuria and maintained remission in a patient unresponsive to other treatments.
Area of Science:
- Nephrology
- Immunology
- Endocrinology
Background:
- Membranous nephropathy (MN) is a leading cause of nephrotic syndrome in adults.
- Refractory cases of MN have limited treatment options, necessitating novel therapeutic approaches.
Observation:
- A 46-year-old male with refractory MN showed disease progression despite standard treatments including ACE inhibitors, ARBs, diuretics, statins, prednisone, cyclosporine A, and mycophenolate mofetil.
- Initiation of H.P. Acthar Gel led to a substantial decrease in proteinuria from 9,520 mg/dL to 2,948 mg/dL within 10 months.
Findings:
- Following cessation of Acthar Gel, proteinuria continued to decline, reaching 1,628 mg/dL at 13 months and 407 mg/dL at 15 months.
- The patient achieved and maintained remission of MN symptoms for 1.5 years post-treatment.
Implications:
- These findings suggest H.P. Acthar Gel may be an effective and safe therapeutic option for patients with refractory membranous nephropathy.
- Further research into the efficacy and long-term outcomes of Acthar Gel in MN is warranted.
Abstract:
Treatment options for refractory membranous nephropathy are limited. Herein we describe the case of a 46-year-old white male with membranous nephropathy who progressed during 3 years of treatment with antihypertensive agents (specifically angiotensin-converting enzyme inhibitors and angiotensin receptor blockers), diuretics, simvastatin, prednisone, cyclosporine A, and mycophenolate mofetil. Prior to initiation of treatment with H.P. Acthar® Gel, his proteinuria level was 9,520 mg/dL (952.0 g/L) but it decreased to 2,948 mg/dL (294.8 g/L) after 10 months of Acthar therapy. After 13 months, treatment with Acthar was halted as his 24-hour urinary protein was 1,628 mg/dL (162.8 g/L); by 15 months, it was 407 mg/dL (40.7 g/L). The patient has remained free of signs and symptoms of membranous nephropathy for 1.5 years. These results support the use of Acthar as an effective and safe therapy for patients with refractory membranous nephropathy.
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