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Synthetic ACTH in High Risk Patients with Idiopathic Membranous Nephropathy: A
Prospective, Open Label Cohort Study
#MMPMID26562836
van de Logt AE
; Beerenhout CH
; Brink HS
; van de Kerkhof JJ
; Wetzels JF
; Hofstra JM
PLoS One
2015[]; 10
(11
): e0142033
PMID26562836
show ga
New therapeutic agents are warranted in idiopathic membranous nephropathy.
Synthetic ACTH may be advantageous with reported remission rates up to 85% and
few side effects. We conducted a prospective open label cohort study from 2008
till 2010 (NCT00694863). We prospectively selected patients with idiopathic
membranous nephropathy and high risk for progression (defined as
?eta-2-microglobulin (?2m) excretion of >500 ng/min). For comparison, we selected
matched historical controls treated with cyclophosphamide. The prospectively
selected patients received intramuscular injections of synthetic ACTH during 9
months (maximal dose 1 mg twice a week). The primary endpoints concerned the
feasibility and incidence of remissions as a primary event. Secondary endpoints
included side effects of treatment and the incidence of remissions and relapses
at long-term follow-up. Twenty patients (15 men) were included (age 54±14 years,
serum creatinine 104 ?mol/l [IQR 90?113], urine protein:creatinine ratio 8.7 g/10
mmol creatinine [IQR 4.3?11.1]). Seventeen patients (85%) completed treatment.
97% of injections were administered correctly. Cumulative remission rate was 55%
(complete remission in 4 patients, partial remission 7 patients). In a group of
historical controls treated with cyclophosphamide and steroids, 19 of 20 patients
(95%) developed a remission (complete remission in 13 patients, partial remission
in 6 patients) (p<0.01). The main limitation of our study is its small size and
the use of a historical control group. We show that treatment with intramuscular
injections of synthetic ACTH is feasible. Our data suggest that synthetic ACTH is
less effective than cyclophosphamide in inducing a remission in high risk
patients with idiopathic membranous nephropathy. The use of synthetic ACTH was
also associated with many adverse events. Therefore, we advise against synthetic
ACTH as standard treatment in membranous nephropathy.
|Adult
[MESH]
|Cosyntropin/adverse effects/*therapeutic use
[MESH]
free
free
free
