PMID- 35111055
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220204
IS  - 1663-9812 (Print)
IS  - 1663-9812 (Electronic)
IS  - 1663-9812 (Linking)
VI  - 12
DP  - 2021
TI  - Efficacy and Safety of Different Immunosuppressive Therapies in Patients With 
      Membranous Nephropathy and High PLA2R Antibody Titer.
PG  - 786334
LID - 10.3389/fphar.2021.786334 [doi]
LID - 786334
AB  - Background: This study aimed to evaluate clinical features and prognosis and 
      therapy option of patients with different risk ranks based on antibody against 
      the M-type phospholipase-A2-receptor (PLA2Rab) level in seropositive M-type 
      phospholipase-A2-receptor (PLA2R)-associated membranous nephropathy (MN) in a 
      large sample size, multi-center study. Method: Based on the unvalidated cut-off 
      value of PLA2Rab above 150 RU/ml as one of the clinical criteria for high risk of 
      progressive kidney function loss in MN according to 2020 Kidney Disease: 
      Improving Global Outcomes (KDIGO) draft guidelines recommendation, a total of 447 
      patients who received cyclophosphamide (CTX) or tacrolimus (TAC) combined with 
      corticosteroids treatment for 12 months were divided into high titer (>150 RU/ml) 
      group and non-high titer (20-150 RU/ml) group, which were subdivided into CTX 
      subgroup and TAC subgroup. The overall cohort was classified into CTX group and 
      TAC group as well. Clinical parameters levels and remission rates were recorded 
      at 3, 6, and 12 months follow-up. PLA2Rab was tested by enzyme-linked 
      immunosorbent assay. Results: Patients with high titer PLA2Rab were associated 
      with more severe proteinuria and hypoalbuminemia compared to those with non-high 
      titer antibody, accompanied by lower complete remission (CR) and total remission 
      (TR) rates at 3, 6, and 12 months, which even took longer to remission. Similar 
      remission rates differences between the two titer groups were observed in the CTX 
      and TAC groups, respectively. PLA2Rab level at baseline was an independent 
      predictive factor for CR and TR. In the high titer group, CR and TR rates in the 
      CTX subgroup were significantly higher than those in the TAC subgroup at 
      12 months, although serious adverse events were more frequent in the former. 
      Conclusion: High-risk rank patients with PLA2Rab level above 150 RU/ml have 
      higher disease activity and worse prognosis among patients with seropositive 
      PLA2R-associated MN, even under different immunosuppressive therapeutic models; 
      moreover, CTX combined with corticosteroids was preferred compared to TAC plus 
      corticosteroids, although serious adverse events were more frequent in the 
      former. Additionally, baseline PLA2Rab level was an independent predictive factor 
      for clinical remission.
CI  - Copyright (c) 2022 Deng, Huang, Wang, Luo, Liu, Yan, Jiang and Xu.
FAU - Deng, Le
AU  - Deng L
AD  - Department of Nephrology, The Second Affiliated Hospital of Nanchang University, 
      Jiangxi, China.
FAU - Huang, Qipeng
AU  - Huang Q
AD  - Department of Nephrology, The Fifth Affiliated Hospital of Jinan University, 
      Heyuan, China.
FAU - Wang, Jiang
AU  - Wang J
AD  - Department of Hemodialysis, Jiujiang Hospital of Traditional Chinese Medicine, 
      Jiangxi, China.
FAU - Luo, Kaiping
AU  - Luo K
AD  - Department of Nephrology, Ganzhou City People's Hospital, Ganzhou, China.
FAU - Liu, Jiarong
AU  - Liu J
AD  - Department of Nephrology, The Second Affiliated Hospital of Nanchang University, 
      Jiangxi, China.
FAU - Yan, Wenjun
AU  - Yan W
AD  - Department of Nephrology, The First Affiliated Hospital of Gannan Medical 
      University, Jiangxi, China.
FAU - Jiang, Fang
AU  - Jiang F
AD  - Department of Nephrology, Xinyu City People's Hospital, Jiangxi, China.
FAU - Xu, Gaosi
AU  - Xu G
AD  - Department of Nephrology, The Second Affiliated Hospital of Nanchang University, 
      Jiangxi, China.
LA  - eng
PT  - Journal Article
DEP - 20220117
PL  - Switzerland
TA  - Front Pharmacol
JT  - Frontiers in pharmacology
JID - 101548923
PMC - PMC8801920
OTO - NOTNLM
OT  - immunosuppressive therapy
OT  - membranous nephropathy
OT  - phospholipase A2 receptor
OT  - prognosis
OT  - remission
COIS- The authors declare that the research was conducted in the absence of any 
      commercial or financial relationships that could be construed as a potential 
      conflict of interest.
EDAT- 2022/02/04 06:00
MHDA- 2022/02/04 06:01
PMCR- 2022/01/17
CRDT- 2022/02/03 05:33
PHST- 2021/09/30 00:00 [received]
PHST- 2021/11/22 00:00 [accepted]
PHST- 2022/02/03 05:33 [entrez]
PHST- 2022/02/04 06:00 [pubmed]
PHST- 2022/02/04 06:01 [medline]
PHST- 2022/01/17 00:00 [pmc-release]
AID - 786334 [pii]
AID - 10.3389/fphar.2021.786334 [doi]
PST - epublish
SO  - Front Pharmacol. 2022 Jan 17;12:786334. doi: 10.3389/fphar.2021.786334. 
      eCollection 2021.