@article{3056496,
    title = "Immunosuppressive regimens based on Cyclophospamide or Calcineurin inhibitors: Comparison of their effect in the long term outcome of Primary Membranous Nephropathy",
    author = "Stangou, M. and Marinaki, S. and Papachristou, E. and Kolovou, K. and Sambani, E. and Zerbala, S. and Papadea, P. and Balafa, O. and Rapsomanikis, K.-P. and Andrikos, A. and Manolakaki, P. and Papadopoulou, D. and Mitsopoulos, E. and Liakou, H. and Andronikidi, P.-E. and Choulitoudi, V. and Moustakas, G. and Galitsiou, D. and Dafnis, E. and Stylianou, K. and Stefanidis, I. and Golfinopoulos, S. and Panagoutsos, S. and Tsilivigkou, M. and Papadogianakis, A. and Tzanakis, I. and Sioulis, A. and Vlachakos, D. and Grapsa, E. and Spaia, S. and Kaperonis, N. and Paliouras, C. and Dioudis, C. and Papoulidou, F. and Apostolou, T. and Iatrou, C. and Boletis, I. and Goumenos, D. and Papagianni, A.",
    journal = "PLOS ONE",
    year = "2019",
    volume = "14",
    number = "8",
    publisher = "Public Library of Science",
    doi = "10.1371/journal.pone.0217116",
    keywords = "angiotensin receptor antagonist;  calcineurin inhibitor;  cyclophosphamide;  cyclosporine;  methylprednisolone;  prednisolone;  renin angiotensin aldosterone system inhibitor;  steroid;  tacrolimus;  unclassified drug;  calcineurin inhibitor;  cyclophosphamide;  immunosuppressive agent, adolescent;  adult;  aged;  Article;  clinical feature;  cohort analysis;  controlled study;  drug blood level;  drug dose reduction;  drug efficacy;  drug tolerance;  female;  follow up;  histopathology;  human;  human tissue;  immunosuppressive treatment;  kidney function;  long term outcome;  major clinical study;  male;  membranous glomerulonephritis;  outcome assessment;  primary membranous nephropathy;  primary membranous nephropathy;  recurrence risk;  remission;  renin angiotensin aldosterone system;  retrospective study;  treatment duration;  treatment outcome;  treatment response;  comparative study;  membranous glomerulonephritis;  middle aged;  treatment outcome;  very elderly;  young adult, Adolescent;  Adult;  Aged;  Aged, 80 and over;  Calcineurin Inhibitors;  Cyclophosphamide;  Female;  Glomerulonephritis, Membranous;  Humans;  Immunosuppressive Agents;  Male;  Middle Aged;  Retrospective Studies;  Treatment Outcome;  Young Adult",
    abstract = "Introduction Management of the Primary Membranous Nephropathy (PMN) usually involves administration of immunosuppressives. Cyclophosphamide (Cyclo) and Calcineurin Inhibitors (CNIs) are both widely used but only limited data exist to compare their efficacy in long term followup. Aim The aim of the present study was to estimate and compare long term effects of Cyclo and CNIs in patients with PMN. Patients-methods Clinical data, histologic findings and long term outcome were retrospectively studied. The response to treatment and rate of relapse was compared between patients treated with CNIs or Cyclo based immunosuppressive regimens. Results Twenty three centers participated in the study, with 752 PMN patients (Mean age 53.4(14- 87) yrs, M/F 467/285), followed for 10.1±5.7 years. All patients were initially treated with Renin Angiotensin Aldosterone System inhibitors (RAASi) for at least 6 months. Based on their response and tolerance to initial treatment, patients were divided into 3 groups, group I with spontaneous remission, who had no further treatment, group II, continued on RAASi only, and group III on RAASi+immunosuppression. Immunosuppressive regimes were mainly based on CNIs or Cyclo. Frequent relapses and failure to treatment were more common between patients who had started on CNIs (n = 381) compared to those initially treated with Cyclo (n = 110), relapse rate: 25.2% vs. 6.4%, p<0.0001, and no response rate: 22.5% vs. 13.6%, p = 0.04, respectively. Conclusions Long term follow up showed that administration of Cyclo in PMN is followed by better preservation of renal function, increased response rate and less frequent relapses, compared to CNIs. © 2019 Stangou et al."
}