Controlled Trial of Methylprednisolone and Chlorambucil in Idiopathic Membranous Nephropathy

TLDR

Sixty‑seven adults with idiopathic membranous nephropathy and nephrotic syndrome were randomized to symptomatic treatment alone or to a six‑month course of methylprednisolone alternated with chlorambucil every other month, with follow‑up ranging from one to seven years. At a mean follow‑up of 31–37 months, 23 of 32 treated patients achieved complete or partial remission versus 9 of 30 controls (P = 0.001), with 12 complete remissions in the treated group compared to two in controls; renal function remained stable in the treated group while it declined in controls, and only two patients experienced adverse effects leading to discontinuation. Published in N Engl J Med 1984; 310:946–950.

Abstract

Sixty-seven adults with idiopathic membranous nephropathy and the nephrotic syndrome were randomly assigned to symptomatic treatment only or to a six-month course of methylprednisolone alternated with chlorambucil every other month. Patients were followed for one to seven years. At the end of follow-up (mean of 31.4±18.2 months for the treated group and 37.0±22.0 for the control group) 23 of 32 treated patients were in complete or partial remission, as compared with 9 of 30 control patients (P = 0.001). Twelve of the treated patients were in complete remission, as compared with only two of the controls. In the treated group there were no changes in renal function during follow-up, whereas in the control group the reciprocal of the plasma creatinine level, which is proportional to the creatinine clearance, decreased significantly (P = 0.00017) after two years of follow-up. Side effects were minimal in all treated patients except two, who were dropped from the study because of peptic ulcer and gastric intolerance to chlorambucil. We conclude that steroid and chlorambucil treatment for six months favors remission of the nephrotic syndrome in adults with idiopathic membranous nephropathy and can preserve renal function for at least some years. (N Engl J Med 1984; 310:946–50.)