The Efficacy of an Initial Prednisone Monotherapy Regimen on PLA2R-associated Idiopathic Membranous Nephropathy

Area of Science:

• Nephrology
• Immunology

Background:

• Idiopathic membranous nephropathy (IMN) is a leading cause of nephrotic syndrome in adults.
• Phospholipase A2 receptor (PLA2R) antibodies are implicated in the pathogenesis of IMN.
• Current treatments for PLA2R-associated IMN include immunosuppressive regimens like the Ponticelli regimen.

Purpose of the Study:

• To evaluate the efficacy and safety of prednisone monotherapy versus the Ponticelli regimen in patients with PLA2R-associated IMN.
• To compare nephrotic syndrome remission rates at 12 months between the two treatment groups.
• To assess and compare the incidence of adverse events and disease recurrence over a 12-month follow-up period.

Main Methods:

• Retrospective cohort study of 32 patients with PLA2R-associated IMN.
• Patients received either prednisone monotherapy (n=17) or the Ponticelli regimen (n=15).
• Primary outcome: nephrotic syndrome remission at 12 months. Secondary outcomes: adverse events and recurrence.

Main Results:

• Remission rates at 12 months were similar: 94.1% for prednisone monotherapy and 93.3% for the Ponticelli regimen (p=0.19).
• Adverse events occurred in 9/17 patients (prednisone) and 9/15 patients (Ponticelli) (p=0.74).
• Relapse rates were comparable: 4 patients (prednisone) and 3 patients (Ponticelli) (p=0.99).

Conclusions:

• Prednisone monotherapy demonstrates similar efficacy and safety compared to the Ponticelli regimen for PLA2R-associated IMN.
• Prednisone monotherapy represents a viable alternative treatment option for PLA2R-associated IMN.
• Further prospective studies are warranted to confirm these findings.