William G. Couser. Primary Membranous Nephropathy. CJASN June 07, 2017 12: (6) 983–997; published ahead of print May 26, 2017, doi:10.2215/CJN.11761116.
Due to author error, two doses were incorrectly reported in Table 6 of the above referenced article. The doses in the text are correct. The correct doses for Table 6 are:
The dose of Rituximab is 375 mg/M2.
The dose of Prednisone with Cyclosporin is 5–10 mg.
Table 6.
Summary of the most common IST protocols for treating patients with primary membranous nephropathy (56–60,93)
| IST Regimen | Drug, Dose | Comments |
|---|---|---|
| Cytotoxic drugs | KDIGO first choice | |
| Modified Ponticelli | Months 1, 3, 5: 1 g methylprednisolone iv on days 1, 2, and 3 followed by oral prednisone, 0.5 mg/kg daily for 27 d | Monitor Uprotein and WBC weekly ×8, then every 2 mo; daily oral prednisone and cyclophosphamide may have similar efficacy. Increased risk of malignancy above 36 g |
| Months 2, 4, 6: 2.0–2.5 mg/kg oral cyclophosphamide daily | Relapse rate 20%–30% | |
| Dutch protocol | Months 1, 3, 5: 1 g MP days 1–3 followed by oral prednisone, 0.5–1.0 mg/kg for 6 mo, then taper | Same as above |
| Oral cyclophosphamide, 1.5–2.0 mg/kg daily for 12 mo | ||
| CNIs | KDIGO second choice | |
| Cyclosporin | 3.5–5.0 mg/kg daily in divided doses adjusted to level of 120–200 μg/L for 12–18 mo and tapered | Used in patients resistant to cytotoxic drugs but can be used as initial therapy. Taper slowly |
| Prednisone 5–10 mg daily or alt days | Discontinue at 6 mo if no response | |
| Relapse rate 40%–50% | ||
| Tacrolimus | 0.05–0.075 mg/kg daily in two divided doses adjusted to level of 3–5 μg/L for 12–18 mo and taper slowly | Same as above |
| Prednisone 5–10 mg/kg per day daily or alt days | Preferable in young women | |
| B cell depletion | Used for patients resistant to cytotoxic drugs or CNIs | |
| Utility as initial therapy not yet established by RCTs | ||
| Rituximab | 375 mg/M2 weekly times 4 | Follow CD20 counts and repeat dose if counts rise before remission in proteinuria or relapse occurs |
| 375 mg/M2 once and follow CD20 counts | ||
| 1000 mg on days 1 and 15 | ||
| ACTH | ||
| Tetracosactrin (Synacthen) (synthetic) | 1 mg IM every 2 wk for 6–12 mo | |
| Corticotropin (ACTHAR) (purified) | 80 U IM every 2 wk for 6–12 mo |
IST, immunosuppressive therapy; KDIGO, Kidney Disease Improving Global Outcomes; WBC, white blood cells; MP, methylprednisolone; CNI, calcineurin inhibitor; alt, alternate; RCT, randomized controlled trial; ACTH, adrenocorticotrophic hormone; IM, intramuscular.
Footnotes
Published online ahead of print. Publication date available at www.cjasn.org.