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首页> 美国卫生研究院文献>American Journal of Translational Research >Combination of ultra-low dose rituximab and low dose tacrolimus versus tacrolimus alone in the treatment of non-responsive idiopathic membranous nephropathy: a Chinese retrospective cohort study
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Combination of ultra-low dose rituximab and low dose tacrolimus versus tacrolimus alone in the treatment of non-responsive idiopathic membranous nephropathy: a Chinese retrospective cohort study

机译：超低剂量rituximab和低剂量曲粒蛋白酶与巨积司的组合单独治疗非响应性特发性膜肾病：中国回顾性队列研究

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Introduction: Some patients with idiopathic membranous nephropathy (iMN) do not respond to cyclophosphamide plus steroids treatment, and we define them as non-responsive iMN. The combined regimen of rituximab (RTX) and tacrolimus (TAC) has an excellent effect on this kind of non-responsive iMN patients; however, the optimal dose is still unclear. In this retrospective study, we comapred the efficacy and safety of ultra-low dose RTX plus low-dose TAC therapy versus standard TAC monotherapy in patients with non-responsive iMN. Materials and methods: Sixty-seven Chinese non-responsive iMN patients were included. There were 41 patients received standard tacrolimus monotherapy (TAC) and 26 patients received ultra-low dose rituximab plus low dose tacrolimus (RTX/TAC) combination therapy. All patients were observed for 12 months. Results: 18 patients (18/26, 69.2%) in the RTX/TAC group and 17 patients (17/41, 41.5%) in the TAC group achieved clinical response after 12-month follow-up (P=0.044). The median time for achieving response in the two groups was 3.0 months. As indicated by Kaplan-Meier curve, the response rate in the RTX/TAC group was higher than that in the TAC group (P=0.015). 24-hour proteinuria, serum albumin, estimated glomerular filtration rate (eGFR) and serum creatinine in the two groups were comparable at baseline; howerver, after 12-month follow up, they were significantly improved in the RTX/TAC group compared with the TAC group (P<0.05). B-cell depletion was achieved in all patients in the RTX/TAC group during the whole follow-up period. Pneumonia, urinary tract infections and glucose intolerance were the major side effects observed in this study. All adverse events were mild, and the cumulative incidence was lower in the RTX/TAC group compared with that in the TAC group (9 (34.6%) vs 27 (65.9%), P=0.023). Conclusion: The combination of ultra-low dose rituximab and low dose tacrolimus is more effective in inducing proteinuria response, improving eGFR and serum albumin in non-responsive iMN patients than standard tacrolimus monotherapy. The combined treatment also has higher safty.
机译：简介：一些特发性膜肾病（IMN）患者不响应环磷酰胺加类固醇处理，我们将它们定义为非响应IMN。 Rituximab（RTX）和Tacrolimus（TAC）的组合方案对这种非反应IMN患者具有很好的效果;然而，最佳剂量尚不清楚。在这项回顾性研究中，我们对非响应IMN患者进行了超低剂量RTX加低剂量TAC治疗的疗效和安全性与标准TAC单药治疗的疗效和安全性。材料和方法：包括六十七名中国非响应IMN患者。有41名患者接受标准巨杆菌单疗法（TAC）和26名患者接受超低剂量RITUXIMAB加低剂量标准蛋白（RTX / TAC）组合治疗。所有患者均已观察到12个月。结果：18例患者（18/26,69.2％）在rTX / TAC组和17名患者（17/41,41.5％）在TAC组后达到12个月随访后的临床反应（P = 0.044）。在两组中实现反应的中位时间为3.0个月。如Kaplan-Meier曲线所示，RTX / TAC组的响应速率高于TAC组中的响应速率（P = 0.015）。在两组中，24小时蛋白尿，血清白蛋白，估计的肾小球过滤速率（EGFR）和血清肌酐在基线上进行了比较; 12个月后续后，Howerver在rTX / TAC组后显着改善，与TAC组相比（P <0.05）。在整个后续期间，在RTX / TAC组的所有患者中达到了B细胞耗尽。肺炎，泌尿道感染和葡萄糖不耐受是本研究中观察到的主要副作用。所有不良事件均为温和，与TAC组中的rTx / TAC组中的累积发病率降低（9（34.6％）Vs 27（65.9％），P = 0.023）。结论：超低剂量rituximab和低剂量标准蛋白的组合在诱导蛋白尿反应中更有效，在非反应IMN患者中改善EGFR和血清白蛋白，而不是标准的巨杆菌单疗法。合并的治疗也具有更高的安全性。

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