Efficacy and safety of a modified- ‘modified ponticelli’ regimen for treatment of primary membranous nephropathy

Indu Ramachandra Rao, Ravindra Prabhu Attur, Dharshan Rangaswamy, Srinivas Shenoy, Sindhura Lakshmi Koulmane Laxminarayana, Shankar Prasad Nagaraju

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Modified Ponticelli regimen (mPR), consisting of cyclical steroids and cyclophosphamide, is the most established therapy for primary membranous nephropathy (MN). Yet, the potential toxicity of this treatment regimen poses a significant concern. Objectives: The aim of this study was to assess the efficacy and safety of a modified version of the conventional mPR for primary MN using lower-than-standard dose pulse steroids. Patients and Methods: This was a retrospective single-center analysis of patients admitted between January 2008 to December 2017. All treatment-naive patients with biopsy-proven primary MN treated with a lower-than-standard dose pulse steroid-based modification of the conventional mPR (intravenous pulse of 500 mg methyl-prednisolone, instead of 1000 mg) were included. We report the remission rates at the end of 6 months (both complete and partial), relapses and adverse effects of treatment at the end of follow-up. Results: A total of 41 individuals were included. Of 31 individuals who completed six months of treatment (six were lost to follow-up, while four discontinued immunosuppression due to infections), 71% (n=22) responded to treatment [complete remission in 25.8% (n=8), partial remission in 45.2% (n=14)]. Most common complications detected throughout the treatment were steroid induced diabetes mellitus in 40% (n=14/35), infections in 25.7% (of which immunosuppression was discontinued for four participants), and leucopenia in 8.5% (n=3/35). Relapses were seen in 29% (n=9) during follow-up (mean follow-up period: 36 months). Conclusions: The modified- ‘modified Ponticelli’ regimen with lower-than-standard dose intravenous steroids and cyclophosphamide was efficient in attaining remission in primary MN.

Original languageEnglish
Article numbere25
JournalJournal of Nephropathology
Volume8
Issue number3
DOIs
Publication statusPublished - 01-07-2019

Fingerprint

Membranous Glomerulonephritis
Safety
Steroids
Cyclophosphamide
Immunosuppression
Therapeutics
Recurrence
Lost to Follow-Up
Leukopenia
Prednisolone
Infection
Diabetes Mellitus
Biopsy

All Science Journal Classification (ASJC) codes

  • Nephrology

Cite this

Rao, Indu Ramachandra ; Attur, Ravindra Prabhu ; Rangaswamy, Dharshan ; Shenoy, Srinivas ; Laxminarayana, Sindhura Lakshmi Koulmane ; Nagaraju, Shankar Prasad. / Efficacy and safety of a modified- ‘modified ponticelli’ regimen for treatment of primary membranous nephropathy. In: Journal of Nephropathology. 2019 ; Vol. 8, No. 3.
@article{5eb50197f63a4046a47a0cdf09782fa0,
title = "Efficacy and safety of a modified- ‘modified ponticelli’ regimen for treatment of primary membranous nephropathy",
abstract = "Background: Modified Ponticelli regimen (mPR), consisting of cyclical steroids and cyclophosphamide, is the most established therapy for primary membranous nephropathy (MN). Yet, the potential toxicity of this treatment regimen poses a significant concern. Objectives: The aim of this study was to assess the efficacy and safety of a modified version of the conventional mPR for primary MN using lower-than-standard dose pulse steroids. Patients and Methods: This was a retrospective single-center analysis of patients admitted between January 2008 to December 2017. All treatment-naive patients with biopsy-proven primary MN treated with a lower-than-standard dose pulse steroid-based modification of the conventional mPR (intravenous pulse of 500 mg methyl-prednisolone, instead of 1000 mg) were included. We report the remission rates at the end of 6 months (both complete and partial), relapses and adverse effects of treatment at the end of follow-up. Results: A total of 41 individuals were included. Of 31 individuals who completed six months of treatment (six were lost to follow-up, while four discontinued immunosuppression due to infections), 71{\%} (n=22) responded to treatment [complete remission in 25.8{\%} (n=8), partial remission in 45.2{\%} (n=14)]. Most common complications detected throughout the treatment were steroid induced diabetes mellitus in 40{\%} (n=14/35), infections in 25.7{\%} (of which immunosuppression was discontinued for four participants), and leucopenia in 8.5{\%} (n=3/35). Relapses were seen in 29{\%} (n=9) during follow-up (mean follow-up period: 36 months). Conclusions: The modified- ‘modified Ponticelli’ regimen with lower-than-standard dose intravenous steroids and cyclophosphamide was efficient in attaining remission in primary MN.",
author = "Rao, {Indu Ramachandra} and Attur, {Ravindra Prabhu} and Dharshan Rangaswamy and Srinivas Shenoy and Laxminarayana, {Sindhura Lakshmi Koulmane} and Nagaraju, {Shankar Prasad}",
year = "2019",
month = "7",
day = "1",
doi = "10.15171/jnp.2019.25",
language = "English",
volume = "8",
journal = "Journal of Nephropathology",
issn = "2251-8363",
publisher = "Society of Diabetic Nephropathy Prevention",
number = "3",

}

Efficacy and safety of a modified- ‘modified ponticelli’ regimen for treatment of primary membranous nephropathy. / Rao, Indu Ramachandra; Attur, Ravindra Prabhu; Rangaswamy, Dharshan; Shenoy, Srinivas; Laxminarayana, Sindhura Lakshmi Koulmane; Nagaraju, Shankar Prasad.

In: Journal of Nephropathology, Vol. 8, No. 3, e25, 01.07.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Efficacy and safety of a modified- ‘modified ponticelli’ regimen for treatment of primary membranous nephropathy

AU - Rao, Indu Ramachandra

AU - Attur, Ravindra Prabhu

AU - Rangaswamy, Dharshan

AU - Shenoy, Srinivas

AU - Laxminarayana, Sindhura Lakshmi Koulmane

AU - Nagaraju, Shankar Prasad

PY - 2019/7/1

Y1 - 2019/7/1

N2 - Background: Modified Ponticelli regimen (mPR), consisting of cyclical steroids and cyclophosphamide, is the most established therapy for primary membranous nephropathy (MN). Yet, the potential toxicity of this treatment regimen poses a significant concern. Objectives: The aim of this study was to assess the efficacy and safety of a modified version of the conventional mPR for primary MN using lower-than-standard dose pulse steroids. Patients and Methods: This was a retrospective single-center analysis of patients admitted between January 2008 to December 2017. All treatment-naive patients with biopsy-proven primary MN treated with a lower-than-standard dose pulse steroid-based modification of the conventional mPR (intravenous pulse of 500 mg methyl-prednisolone, instead of 1000 mg) were included. We report the remission rates at the end of 6 months (both complete and partial), relapses and adverse effects of treatment at the end of follow-up. Results: A total of 41 individuals were included. Of 31 individuals who completed six months of treatment (six were lost to follow-up, while four discontinued immunosuppression due to infections), 71% (n=22) responded to treatment [complete remission in 25.8% (n=8), partial remission in 45.2% (n=14)]. Most common complications detected throughout the treatment were steroid induced diabetes mellitus in 40% (n=14/35), infections in 25.7% (of which immunosuppression was discontinued for four participants), and leucopenia in 8.5% (n=3/35). Relapses were seen in 29% (n=9) during follow-up (mean follow-up period: 36 months). Conclusions: The modified- ‘modified Ponticelli’ regimen with lower-than-standard dose intravenous steroids and cyclophosphamide was efficient in attaining remission in primary MN.

AB - Background: Modified Ponticelli regimen (mPR), consisting of cyclical steroids and cyclophosphamide, is the most established therapy for primary membranous nephropathy (MN). Yet, the potential toxicity of this treatment regimen poses a significant concern. Objectives: The aim of this study was to assess the efficacy and safety of a modified version of the conventional mPR for primary MN using lower-than-standard dose pulse steroids. Patients and Methods: This was a retrospective single-center analysis of patients admitted between January 2008 to December 2017. All treatment-naive patients with biopsy-proven primary MN treated with a lower-than-standard dose pulse steroid-based modification of the conventional mPR (intravenous pulse of 500 mg methyl-prednisolone, instead of 1000 mg) were included. We report the remission rates at the end of 6 months (both complete and partial), relapses and adverse effects of treatment at the end of follow-up. Results: A total of 41 individuals were included. Of 31 individuals who completed six months of treatment (six were lost to follow-up, while four discontinued immunosuppression due to infections), 71% (n=22) responded to treatment [complete remission in 25.8% (n=8), partial remission in 45.2% (n=14)]. Most common complications detected throughout the treatment were steroid induced diabetes mellitus in 40% (n=14/35), infections in 25.7% (of which immunosuppression was discontinued for four participants), and leucopenia in 8.5% (n=3/35). Relapses were seen in 29% (n=9) during follow-up (mean follow-up period: 36 months). Conclusions: The modified- ‘modified Ponticelli’ regimen with lower-than-standard dose intravenous steroids and cyclophosphamide was efficient in attaining remission in primary MN.

UR - http://www.scopus.com/inward/record.url?scp=85071835366&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85071835366&partnerID=8YFLogxK

U2 - 10.15171/jnp.2019.25

DO - 10.15171/jnp.2019.25

M3 - Article

AN - SCOPUS:85071835366

VL - 8

JO - Journal of Nephropathology

JF - Journal of Nephropathology

SN - 2251-8363

IS - 3

M1 - e25

ER -