Efficiency And Safety Of Thalidomide Combined With Dexamethasone In Patients With Proliferative Glomerulonephritis With Monoclonal IgG Deposits

Objective:To evaluate the efficacy and safety of thalidomide combined with dexamethasone(TD)in patients with proliferative glomerulonephritis with monoclonal IgG deposits(PGNMID).Methodology:We retrospectively analyzed the clinical data of 12 patients diagnosed with PGNMID from December 2015 to November 2017,and 32 PGNMID patients treated with non-TD regimen from 2011 to 2016.Chi square test was used to compare the difference between the two remission rates.Results:They are 4 males and 8 females with a median age of 48.5(27,63)years taking the regimen of TD.With a mean follow-up of 7.5 months,6(50%)patients achieve renal response,includes 2(16.7%)patients achieving complete response and 4(33.3%)patients achieving partial response,median time of response was 5.5 months.5(83.3%)patients got hematological response,in which 1(16.7%)patients obtain complete response,2(33.3%)patients obtain very good partial response and 2(33.3%)patients obtain partial response.After treatment,serum albumin was significantly improved(P=0.002),serum creatinine kept stable(P=0.79),urine protein decreased(P=0.099),and no patient progressed to ESRD.Compared with the TD group,the mean follow-up time of non-TD group was 19 months.In this group,5(15.63%)patients achieve renal response,including 3(9.38%)patients achieving complete response and 2(6.25%)patients achieving partial response.The renal response rate was lower than those in TD group(P=0.045).3(33.3%)patients got hematological response.Serum creatinine in the last follow-up were worse than the baseline(P=0.046),albumin(P=0.005)and proteinuria(P=0.044)were improved,and 8(25%)patients progressed to ESRD with an average time of 25.2 months.The survival curve shows it seemed that there is a difference between the two groups,but there is no statistical meaning.The common side effects of TD group were mainly numbness(50%),edema(50%),sleepiness(50),and skin lesions(33%),but most of the patients were tolerable through symptomatic treatment and drug reduction.The mainly adverse effects in non-TD group were infection,including respiratory infection,digestive infection and skin infection.Conclusion:The TD regiment is effective for PGNMID patients.Side effects are common but most of the patients can tolerate it.The long-term effect needs further study.