Assessing the Rates of Complications in Patients with Membranous Nephropathy Treated with Cyclical Intravenous Cyclophosphamide and Oral Prednisolone: A Single-Centre Experience

Background: The Modified Ponticelli Regimen (MPR) is an established treatment option for membranous nephropathy (MN). We use a modified MPR at our centre, administering intravenous (IV) Cyclophosphamide (CP) at the start of months 2,4 and 6. Oral Prednisolone 40mg is prescribed daily during months 1,3 and 5 without the use of IV Methylprednisolone. We reviewed whether minimising the dosage of CP and steroids reduces complication rates without compromising on remission rates. Methods: All patients treated with the modified MPR at our centre were included for analysis. Patients were followed up till either their most recent clinic visit, until they switched immunosuppressive treatment, died or left our locality. We looked at the complications during follow-up, defined as either: leucopenia; severe infection requiring hospitalisation; or hyperglycaemia requiring hospitalisation or insulin initiation. Results: 44 individuals were identified: 35 (80%) were male; 36 (81%) were of white ethnicity; the median age was 65 (IQR 58-69) years; 2 (5%) had diabetes mellitus. 39 (87%) completed the full course and the mean total CP dose was 3.1 g (range 1.3-4.5g). The median follow-up was 1.8 years (IQR.1.0-4.1). 25/39 (64.1%) achieved remission, 8 of whom (20.51%) reached CR. None became leucopenic, 10 (22.7%) sustained serious infections requiring hospitalisation and 1 (2.3%) needed admission with a hyperglycaemia (blood glucose of 74mmol/L or 1333mg/dL). The infections individuals were admitted with are summarised below, with some patients admitted more than once or with more than one source. Conclusion: Our modified MPR regime resulted in a comparable remission rate to other studies using a standard MPR (66% for Jha et al. (2007) and 71% for Rao et al. (2019)) but demonstrated a marked reduction in complication rates, particularly in relation to leucopenia and diabetes-related complications: comparative studies using a standard MPR show leucopenia rates of 8.5-42%, infection rates of 25.7-35.7% and hyperglycaemia-related complications of 1.5-40%. Our data suggests that our modified MPR maintains efficacy and reduces treatment-related toxicity. - Infection Type Respiratory Gastrointestinal Urine Line Unknown Number of Patients 8 2 1 1 1