Efficacy and safety of a modified- ‘modified Ponticelli’regimen for treatment of primary membranous nephropathy

Modified Ponticelli regimen (mPR), consisting of cyclical steroids and cyclophosphamide, is the most established therapy for primary membranous nephropathy (MN). Yet, the potential
toxicity of this treatment regimen poses a significant concern.

The aim of this study was to assess the efficacy and safety of a modified version of the conventional mPR for primary MN using lower-than-standard dose pulse steroids. This was a retrospective single-center analysis of patients admitted between January 2008 to December 2017. All treatment-naive patients with biopsy-proven primary MN treated with a lower-than-standard dose pulse steroid-based modification of the conventional mPR (intravenous pulse of 500 mg methyl-prednisolone, instead of 1000 mg) were included. We report the remission rates at the end of 6 months (both complete and partial), relapses and adverse effects of treatment at the end of follow-up.

A total of 41 individuals were included. Of 31 individuals who completed six months of treatment (six were lost to follow-up, while four discontinued immunosuppression due to infections),71% (n=22) responded to treatment [complete remission in 25.8% (n=8), partial remission in 45.2% (n=14)]. Most common complications detected throughout the treatment were steroid induced diabetes mellitus in 40% (n=14/35), infections in 25.7% (of which immunosuppression was discontinued for four participants), and leucopenia in 8.5% (n=3/35). Relapses were seen in 29% (n=9) during follow-up (mean follow-up period: 36 months).

The modified- ‘modified Ponticelli’ regimen with lower-than-standard dose intravenous steroids and cyclophosphamide was efficient in attaining remission in primary MN.