Stepwise treatment using corticosteroids alone and in combination with cyclosporine in Korean patients with idiopathic membranous nephropathy

Dong Ho Shin, Mi Jung Lee, Hyung Jung Oh, Hyang Mo Koo, Fa Mee Doh, Hyoung Rae Kim, Jae Hyun Han, Jung Tak Park, SeungHyeok Han, Kyu Hun Choi, TaeHyun Yoo, Shin-Wook Kang

Research output: Contribution to journalArticle

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Abstract

Purpose: We undertook an observational study to investigate the effects of immunosuppressive treatment on proteinuria and renal function in 179 Korean idiopathic membranous nephropathy patients with nephrotic syndrome. Materials and Methods: The primary outcome was regarded as the first appearance of remission and the secondary outcomes as a decline in estimated glomerular filtration rate (eGFR) >50% or initiation of dialysis, and all-cause mortality. Seventy-two (40.2%) and 50 (27.9%) patients were treated with corticosteroids alone (C) and corticosteroids plus cyclosporine (C+C), respectively, whereas 57 (31.8%) did not receive immunosuppressants (NTx). Cyclosporine was added if there was no reduction in proteinuria of >50% from baseline by corticosteroids alone within 3 months. Results: There were no differences in baseline renal function and the amount of proteinuria among the three groups. Overall, complete remission (CR) was achieved in 88 (72.1%) patients by immunosuppressants. In a multivariate analysis adjusted for covariates associated with adverse renal outcome, the probability of reaching CR was significantly higher in the C [hazard ratio (HR), 4.09; p<0.001] and C+C groups (HR, 2.57; p=0.003) than in the NTx group. Kaplan-Meier analysis revealed that 5-year CR rates of C, C+C, and NTx groups were 88.5%, 86.2%, and 56.7% (p<0.001). Ten-year event-free rates for the secondary endpoints in these three groups were 91.7%, 79.9%, and 57.2% (p=0.01). Conclusion: Immunosuppressive treatment was effective in inducing remission and preserving renal function in these patients. Therefore, stepwise treatment using corticosteroids alone and in combination with cyclosporine is warranted in these patients.

Original languageEnglish
Pages (from-to)973-982
Number of pages10
JournalYonsei medical journal
Volume54
Issue number4
DOIs
Publication statusPublished - 2013 Jul 1

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Membranous Glomerulonephritis
Cyclosporine
Immunosuppressive Agents
Adrenal Cortex Hormones
Proteinuria
Kidney
Therapeutics
Kaplan-Meier Estimate
Nephrotic Syndrome
Glomerular Filtration Rate
Observational Studies
Dialysis
Multivariate Analysis
Mortality

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Shin, Dong Ho ; Lee, Mi Jung ; Oh, Hyung Jung ; Koo, Hyang Mo ; Doh, Fa Mee ; Kim, Hyoung Rae ; Han, Jae Hyun ; Park, Jung Tak ; Han, SeungHyeok ; Choi, Kyu Hun ; Yoo, TaeHyun ; Kang, Shin-Wook. / Stepwise treatment using corticosteroids alone and in combination with cyclosporine in Korean patients with idiopathic membranous nephropathy. In: Yonsei medical journal. 2013 ; Vol. 54, No. 4. pp. 973-982.
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abstract = "Purpose: We undertook an observational study to investigate the effects of immunosuppressive treatment on proteinuria and renal function in 179 Korean idiopathic membranous nephropathy patients with nephrotic syndrome. Materials and Methods: The primary outcome was regarded as the first appearance of remission and the secondary outcomes as a decline in estimated glomerular filtration rate (eGFR) >50{\%} or initiation of dialysis, and all-cause mortality. Seventy-two (40.2{\%}) and 50 (27.9{\%}) patients were treated with corticosteroids alone (C) and corticosteroids plus cyclosporine (C+C), respectively, whereas 57 (31.8{\%}) did not receive immunosuppressants (NTx). Cyclosporine was added if there was no reduction in proteinuria of >50{\%} from baseline by corticosteroids alone within 3 months. Results: There were no differences in baseline renal function and the amount of proteinuria among the three groups. Overall, complete remission (CR) was achieved in 88 (72.1{\%}) patients by immunosuppressants. In a multivariate analysis adjusted for covariates associated with adverse renal outcome, the probability of reaching CR was significantly higher in the C [hazard ratio (HR), 4.09; p<0.001] and C+C groups (HR, 2.57; p=0.003) than in the NTx group. Kaplan-Meier analysis revealed that 5-year CR rates of C, C+C, and NTx groups were 88.5{\%}, 86.2{\%}, and 56.7{\%} (p<0.001). Ten-year event-free rates for the secondary endpoints in these three groups were 91.7{\%}, 79.9{\%}, and 57.2{\%} (p=0.01). Conclusion: Immunosuppressive treatment was effective in inducing remission and preserving renal function in these patients. Therefore, stepwise treatment using corticosteroids alone and in combination with cyclosporine is warranted in these patients.",
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Stepwise treatment using corticosteroids alone and in combination with cyclosporine in Korean patients with idiopathic membranous nephropathy. / Shin, Dong Ho; Lee, Mi Jung; Oh, Hyung Jung; Koo, Hyang Mo; Doh, Fa Mee; Kim, Hyoung Rae; Han, Jae Hyun; Park, Jung Tak; Han, SeungHyeok; Choi, Kyu Hun; Yoo, TaeHyun; Kang, Shin-Wook.

In: Yonsei medical journal, Vol. 54, No. 4, 01.07.2013, p. 973-982.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Stepwise treatment using corticosteroids alone and in combination with cyclosporine in Korean patients with idiopathic membranous nephropathy

AU - Shin, Dong Ho

AU - Lee, Mi Jung

AU - Oh, Hyung Jung

AU - Koo, Hyang Mo

AU - Doh, Fa Mee

AU - Kim, Hyoung Rae

AU - Han, Jae Hyun

AU - Park, Jung Tak

AU - Han, SeungHyeok

AU - Choi, Kyu Hun

AU - Yoo, TaeHyun

AU - Kang, Shin-Wook

PY - 2013/7/1

Y1 - 2013/7/1

N2 - Purpose: We undertook an observational study to investigate the effects of immunosuppressive treatment on proteinuria and renal function in 179 Korean idiopathic membranous nephropathy patients with nephrotic syndrome. Materials and Methods: The primary outcome was regarded as the first appearance of remission and the secondary outcomes as a decline in estimated glomerular filtration rate (eGFR) >50% or initiation of dialysis, and all-cause mortality. Seventy-two (40.2%) and 50 (27.9%) patients were treated with corticosteroids alone (C) and corticosteroids plus cyclosporine (C+C), respectively, whereas 57 (31.8%) did not receive immunosuppressants (NTx). Cyclosporine was added if there was no reduction in proteinuria of >50% from baseline by corticosteroids alone within 3 months. Results: There were no differences in baseline renal function and the amount of proteinuria among the three groups. Overall, complete remission (CR) was achieved in 88 (72.1%) patients by immunosuppressants. In a multivariate analysis adjusted for covariates associated with adverse renal outcome, the probability of reaching CR was significantly higher in the C [hazard ratio (HR), 4.09; p<0.001] and C+C groups (HR, 2.57; p=0.003) than in the NTx group. Kaplan-Meier analysis revealed that 5-year CR rates of C, C+C, and NTx groups were 88.5%, 86.2%, and 56.7% (p<0.001). Ten-year event-free rates for the secondary endpoints in these three groups were 91.7%, 79.9%, and 57.2% (p=0.01). Conclusion: Immunosuppressive treatment was effective in inducing remission and preserving renal function in these patients. Therefore, stepwise treatment using corticosteroids alone and in combination with cyclosporine is warranted in these patients.

AB - Purpose: We undertook an observational study to investigate the effects of immunosuppressive treatment on proteinuria and renal function in 179 Korean idiopathic membranous nephropathy patients with nephrotic syndrome. Materials and Methods: The primary outcome was regarded as the first appearance of remission and the secondary outcomes as a decline in estimated glomerular filtration rate (eGFR) >50% or initiation of dialysis, and all-cause mortality. Seventy-two (40.2%) and 50 (27.9%) patients were treated with corticosteroids alone (C) and corticosteroids plus cyclosporine (C+C), respectively, whereas 57 (31.8%) did not receive immunosuppressants (NTx). Cyclosporine was added if there was no reduction in proteinuria of >50% from baseline by corticosteroids alone within 3 months. Results: There were no differences in baseline renal function and the amount of proteinuria among the three groups. Overall, complete remission (CR) was achieved in 88 (72.1%) patients by immunosuppressants. In a multivariate analysis adjusted for covariates associated with adverse renal outcome, the probability of reaching CR was significantly higher in the C [hazard ratio (HR), 4.09; p<0.001] and C+C groups (HR, 2.57; p=0.003) than in the NTx group. Kaplan-Meier analysis revealed that 5-year CR rates of C, C+C, and NTx groups were 88.5%, 86.2%, and 56.7% (p<0.001). Ten-year event-free rates for the secondary endpoints in these three groups were 91.7%, 79.9%, and 57.2% (p=0.01). Conclusion: Immunosuppressive treatment was effective in inducing remission and preserving renal function in these patients. Therefore, stepwise treatment using corticosteroids alone and in combination with cyclosporine is warranted in these patients.

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