Evaluation of Immunotherapy for Idiopathic Membranous Nephropathy Based on Risk Stratification and Pathological Stage.

Background: The treatment options for idiopathic membranous nephropathy (IMN) based on risk stratification and pathological staging unclear.

Methods: This prospective cohort study included patients over 18 years of age with biopsy-proven, estimated glomerular filtration rate > 50 mL/min/1.73m2 IMN, as well as IMN patients at moderate and high risk according to the KDIGO guidelines, with pathological stages II and III, who were treated with tacrolimus (TAC), rituximab (RTX) or cyclophosphamide (CYC). Low-risk patients were divided into supportive care (SC) and non-SC (NSC) groups.

Results: The incidence of complete remission (CR) was significantly greater in the TAC+ glucocorticoids (GC) group than in the RTX and CYC+GC groups in the moderate-risk group at 12 months (P = 0.045). In the high-risk group, the CR rates were 48.0%, 35.6%, and 16.7% in the TAC+GC, CYC+GC, and RTX groups, respectively (P < 0.001), and the average time to CR was the shortest in the TAC+GC group (P = 0.008). In stage II group, TAC+GC group had a higher CR rate and shorter average time to CR (P = 0.001, P = 0.015, respectively). At 6 months, the NSC group had significantly lower mean proteinuria compared to the SC group (P = 0.035), but the overall remission rates remained similar between both groups.

Conclusions: Compared with RTX and CYC+GC groups, TAC+GC group presented a greater rate of CR in moderate and high-risk groups, and had a greater incidence of CR and a shorter average time to CR in the stage II subgroup.