Journal of the American Society of Nephrology, Vol 5, 1553-1558, Copyright © 1995 by American Society of Nephrology

REGULAR ARTICLES

Are cytotoxic agents beneficial in idiopathic membranous nephropathy? A meta-analysis of the controlled trials

TF Imperiale, S Goldfarb and JS Berns
Department of Medicine, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, USA.

The use of cytotoxic agents for the treatment of idiopathic membranous nephropathy is controversial. Although several controlled trials have been published, both the comparison groups and the study findings have varied, resulting in clinical uncertainty. To explore this uncertainty, a meta-analysis of controlled trials of treatment with cyclophosphamide or chlorambucil was performed in patients with idiopathic membranous nephropathy and nephrotic-range proteinuria. Patients in the control groups received only symptomatic treatment or corticosteroids. Descriptive and quantitative data from each trial were abstracted independently. Outcomes included effects of treatment on renal function and proteinuria, with a complete remission (CR) or partial remission (PR) defined as the complete or partial resolution of proteinuria without deterioration of renal function. For patients having either any response (CR or PR) or only a CR, both the relative risk (RR) and the number needed to be treated were calculated. The five trials that satisfied criteria for inclusion in the analysis were clinically and statistically homogeneous. There were no placebo-controlled trials that met the criteria for inclusion. Among the 228 patients in these studies, the RR of achieving any response with cytotoxic agents was 2.3 (95% confidence interval, 1.7 to 3.2) and the RR for a CR was 4.6 (95% confidence interval, 2.2 to 9.3), with respective numbers needed to be treated of 2.9 and 4.7, meaning that between three and five patients would need to be treated with cytotoxic agents to achieve one response. Exclusion of the only nonrandomized trial had no significant effect on the results. Both chlorambucil and cyclophosphamide showed similar beneficial effects.(ABSTRACT TRUNCATED AT 250 WORDS)

This article has been cited by other articles:

				J. Ballarin, R. Poveda, J. Ara, L. Perez, F. Calero, J. M. Grinyo, and R. Romero Treatment of idiopathic membranous nephropathy with the combination of steroids, tacrolimus and mycophenolate mofetil: results of a pilot study Nephrol. Dial. Transplant., November 1, 2007; 22(11): 3196 - 3201. [Abstract] [Full Text] [PDF]

				P.W.G. du Buf-Vereijken, G.W. Feith, D. Hollander, P.G.G. Gerlag, J.J.J.M. Wirtz, T.C. Noordzij, and J.F.M. Wetzels Restrictive use of immunosuppressive treatment in patients with idiopathic membranous nephropathy: high renal survival in a large patient cohort QJM, June 1, 2004; 97(6): 353 - 360. [Abstract] [Full Text] [PDF]

				T M Chan, F K Li, W K Hao, K W Chan, S L Lui, S Tang, and K N Lai Treatment of membranous lupus nephritis with nephrotic syndrome by sequential immunosuppression Lupus, September 1, 1999; 8(7): 545 - 551. [Abstract] [PDF]

Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673