Comparison of tacrolimus with or without prednisone therapy in primary membranous nephropathy : A retrospective clinical study

Abstract Objective: Previous studies have shown tacrolimus monotherapy and dual therapy with tacrolimus and low-dose prednisone as effective treatment modalities in managing membranous nephropathy. However, few studies have compared these therapeutic regimens. We compared the safety and efficacy and relapse rates of following these treatment regimens in primary membranous nephropathy in this study. Methods: One hundred and thirty-two patients(a total of 302 patients were excluded) diagnosed with MN viarenal needle biopsy at the First Affiliated Hospital of Zhengzhou University between January 2015 and June 2019 were retrospectively analyzed. The patients were divided into two groups based on the treatment regimen: (1) tacrolimus and prednisone dual therapy (T+P group, n = 67) treatment group; and (2) tacrolimus monotherapy (T group, n = 65) or the control group. High titer (PLA2Rab>150 RU / ml) may affect the outcome of PMN patients and therefore may be confounding factors, we performed a subgroup analysis to eliminate the bias in the relationship between the treatment regimen and the outcomes. Nineteen patients had a high titer in the T + P group, and 21 patients in the T group had a high titer. Patients were treated for approximately 48 weeks; observations were noted. Results: The T group had a remission rate of 64.62%, while the T + P group had a remission rate of 88.06%; the mean remission times were 21.82±2.66 weeks and 10.80±1.91 weeks, respectively. The relapse rate for the T group was 23.08%, and that for the T + P group was 4.48%. The PLA2Rab levels and 24-hour urine proteinuria levels were significantly different between the two groups.There were no significant differences in serum creatinine levels or glomerular filtration rates between the groups. In addition, the groups had no significant differences in complications, including infection, gastrointestinal syndrome, hepatic dysfunction, hyperglycemia, osteoporosis, and new-onset hypertension. Conclusions: Tacrolimus and low-dose prednisone dual therapy is efficacious in managing MN and lowers the recurrence rate in clinical practice.