| Background:Idiopathic membranous nephropathy(IMN),which does not relieve or decrease glomerular filtration rate for a long period of time,often requires immunosuppressive therapy.There are a wide range of immunosuppression and the effect of these medications on IMN is different.At the same time,many immunosuppressive agents have side effects.There is still a lot of controversy about which immunosuppressant is used to treat IMN.In a randomized controlled trial(RCT),tacrolimus(TAC)was found to be effective in the treatment of IMN but the safety and long-term efficacy of the drug were uncertain and TAC had a relapse rate and high cost of treatment.The combination of the drug and the hormone IMN has a high remission rate and is a good choice,but it still has side effects..Tripterygium wilfordii multiglycosides(TWG)have anti-inflammatory and immunosuppressive effects.TWG combined with MP is an effective treatment for IMN,however,it still has corticosteroid-related side effects.Therefore,we performed this retrospective study to investigate the efficacy and safety of TAC combined with TWG ofIMN,which the two drugs are based different mechanism of treatment as well as clinical needs.Methods:This topic is a single center,retrospective study.All patients diagnosed with IMN were recruited from January 2014 to October 2016..Patients selected were treated with at least 5 months of non-immunotherapy and only received tacrolimus combined with methylprednisolone or tacrolimus combined with tripterygium glycosides.According to the different drugs,these patients were grouped.These patients had at least 16 months of follow-up data.The remission rate,recurrence rate,urine protein,and adverse events were compared between the two groups.Results:A total of 120 patients met the enrollment conditions for this study.The included patients’ treatments were tacrolimus combined with methylprednisolone(MP)(TAC + MP group,n=75)and tacrolimus combined with Tripterygium wilfordii polyglycoside(TAC +TWG group,n=45).The remission rates of the TAC+ MP and TAC+TWG group in the 16th month were 80%and 86.7%respectively(P = 0.229).Moreover,the complete remission rates of the TAC+ MP and TAC+TWG group in 16th month were 29.3%and 48.9%respectively(P = 0.031).Compared with TAC+MP group,TAC+ TWG group had a higher rate in remission rate during the ten months(log-rank,P=0.938).Compared with TAC+MP group,TAC+ TWG group had a higher complete remission rate(log-rank,P=0.019,log-rank,P= 0.038 respectively).Comparing with the TAC + MP group,the TAC + TWG group had lower recurrence rates.The decrease in proteinuria was significantly greater in the TAC+TMG group compared with the other two groups in the8h,12th,and 16th months.The times that remission first occurred were at 4.0(2.0)months for the TAC+ TWG group and 3.0(3.0)months for the TAC+ MP group(P=0.212).No irreversible adverse events occurred In all patients.Conclusion:The study of this topic indicated that tacrolimus combined with tripterygium glycosides group has good efficacy and safety in the treatment of IMN.However,limited to research methods and sample size,further randomized controlled trials are needed to evaluate the treatment plan. |
