Efficacy of immunosuppressive therapy in low-risk and intermediate- risk idiopathic membranous nephropathy patients : a 2-year follow-up study.

BACKGROUND

The efficacy and safety of immunosuppressive therapy for low- and intermediate-risk idiopathic membranous nephropathy (IMN) remain unclear.

METHOD: A total of 117 renal biopsy-confirmed idiopathic membranous nephropathy (IMN) patients were retrospectively enrolled from the Department of Nephrology, First Affiliated Hospital of USTC (2021-2023). Participants were stratified by baseline urinary protein-to-creatinine ratio (uPCR): low-risk group (≤ 3.0 g/gCr) vs. intermediate-risk group (> 3.0 g/gCr). The low-risk group included 57 patients, 26 of whom received immunosuppressive agents after a minimum of 3 months of supportive care due to persistent proteinuria. All remaining patients initiated immunosuppressive therapy at enrollment. Total remission rates (TRR, including complete remission rate [CRR] and partial remission rate [PRR]) and CRR were compared at 6, 12, and 24 months, with infectious events documented. Binary logistic regression identified risk factors for remission.

RESULTS

A total of 117 IMN patients were stratified into low-risk (n = 57) and intermediate-risk (n = 60) groups. During the 2-year follow-up, the low-risk group exhibited significantly higher complete remission rates than the intermediate-risk group at 6 months (P < 0.01), 12 months (P < 0.01), and 24 months (P = 0.01). No significant between-group differences in total remission rates were observed at any time point. Binary logistic regression revealed intermediate-risk classification as an independent risk factor for non-remission across all follow-up points (6, 12, and 24 months; all P < 0.05). Male sex was positively associated with complete remission (CR) only at 12 months (OR = 3.24, P = 0.04), whereas no significant associations were detected at 6 and 24 months. Serum triglyceride levels, anti-PLA2R antibody status, and specific immunosuppressive regimens showed no significant correlations with CR at any follow-up time point (all P > 0.05). The overall incidence of infections was comparable between the two groups (P > 0.05), and no deaths occurred throughout follow-up.

CONCLUSION

An observational association was identified between early immunosuppressive therapy and higher CRRs at all follow-up time points in patients with low-risk IMN, with no marked elevation in infectious risk observed. However, this correlation cannot be interpreted as definitive therapeutic benefit due to major confounding factors including unassessed spontaneous remission and absence of a supportive-care-only control group.

CLINICAL TRIAL NUMBER: Not applicable.