Comparison Of The Efficacy Of Tacrolimus Monotherapy Tacrolimus + Hormone Cyclophosphamide + Hormone In The Treatment Of Idiopathic Membaanous

Objective:The purpose of this study was to compare the efficacy and safety among tacrolimus monotherapy,tacrolimus plus prednisone,cyclophosphamide plus prednisone in patients with IMN,then explore best treatment programs for IMN.Methods:126 patients with IMN completed the study,45 patients receivedtacrolimusmonotherapy,54 patients receivedtacrolimusand prednisone,while27 received cyclophosphamide and prednisone.Tacrolimus was given at0.1 mg/kg/d initially divided into 2 equal doses at a 12-hour interval,and adjusted to a blood trough level at 5 to 10 ng/mL based on the results for treatment.Patients in cCTX/GCs group received cyclophosphamide intravenously at 750mg/m~2 body surface each 4 weeks and once in each 2–3?months for the later period,whose accumulative dose was no more than 10g.Oral prednisone was administered at a dose of 1?mg/kg/d for 4?weeks and gradually reduce 5 mg every 2 weeks.When it was reduced to 20 mg/d,it should be slowly reduced.It was reduced by 5 mg each 4weeks until it was reduced to 10 mg/d andmaintained it fora long time.Results:During the 6-month treatment period,The proteinuria of the three groups was significantly reduced,and there was statistical significance before and after treatment.The serum albumin of the three groups increased significantly,andthere was statistically significant before and after treatment.Result suggested that there were no statistically significance among the three groups in the aspects of remission rate at the end of the six-month treatment(62.5%、73.2%、80%,P=0.331).In terms of adverse reactions,the infection rate in the TAC group(17.8%)was significantly lower than those in the TAC/GCs group(38.9%)(P=0.001)and in the CTX/GCs group(51.9%)(P=0.00).The rate of abnormal glucose tolerance in the TAC/GCs group(37.0%)was significantly higher than those in the CTX/GCs group(22.2%)(p=0.018)and in the TAC group(15.6%)(p=0.017).There were 6 patients(13.3%)in the TAC group,9 patients(16.7%)in the TAC/GCs group,and 4 patients(14.8%)in the CTX/GCs group developed renal impairment.There was no statistically significance in the aspect of elevated creatinine among the three groups(P=0.914)and no patients developped into end-stage renal disease(ESRD)or withdrew drugs because of elevated creatinine.There were 10 patients(22.2%)in the TAC group,12 patients(22.2%)in the TAC/GCs group,and 2 patients(7.4%)in the CTX/GCs group performed increasing uric acid.There was no statistically significance among the three groups(P=0.221)in terms of increased uric acid.No patients showed gout symptoms such as joint pain.There were 3 patients(6.7%)in the TAC group,4patients(7.4%)in the TAC/GCs group,and 4 patients in the CTX/GCs group(14.8%)performed liver damage.There was no statistically significance in terms of liver damage among the three groups(P=0.446).There was no liver failure or drugs withdrawal due to abnormal liver function.