How is Membranous Nephropathy treated
What treatment options are available for treatment of Membranous Nephropathy?
Rituximab, an anti-CD20 monoclonal antibody, has become a popular choice for treating patients with primary Membranous Nephropathy after small, prospective but uncontrolled cohorts suggested that it can be effective in inducing remission in approximately 60% of patients.
A randomized controlled study of 75 patients with primary MN and proteinuria ≥3.5 g/24 hours compared rituximab therapy plus nonimmunosuppressive treatment with nonimmunosuppressive treatment alone and showed that those treated with rituximab have a remission rate of 65% compared with 34% in the control group at 12 months.
A randomized controlled study comparing rituximab to cyclosporin is currently being conducted.
It should be noted that rituximab has been linked to unusual infections, such as progressive multifocal leukoencephalopathy, and caution should be taken prior to its widespread use until results from larger randomized studies become available.
Both synthetic and natural ACTH have been studied as treatment options for treating patients with Membranous Nephropathy.
Synthetic ACTH administered for 1 year was compared with corticosteroid plus cyclophosphamide or chlorambucil in a randomized study, and synthetic ACTH resulted in equal reduction in proteinuria. Natural ACTH (Acthar Gel) has also been studied as a treatment option at a dose of 80 units twice weekly for at least 12 weeks and was associated with more than 50% reduction in proteinuria.
ACTH is overall well tolerated. Adverse effects include glucose intolerance, swelling, and development of bronze-colored skin, which resolve after the end of the therapy.
ACTH may be a potential therapy in treatment of patients with MN but requires further evaluation to define its role.
