02380nas a2200253   4500000000100000008004100001100001600042700001800058700002200076700001100098700001600109700001600125700001900141700001700160700002400177700001600201700001700217700001800234245015300252300001200405490000600417520168900423022001402112       2017                            d1 aKumar Vinod1 aSakhuja Vinay1 aRamachandran Raja1 aJha V.1 aKumar Vivek1 aYadav Ashok1 aNada Ritambhra1 aRathi Manish1 aPinnamaneni Venkata1 aGhosh Ratan1 aKohli Harbir1 aGupta Krishan00aTwo-Year Follow-up Study of Membranous Nephropathy Treated With Tacrolimus and Corticosteroids Versus Cyclical Corticosteroids and Cyclophosphamide.  a610-6160 v23 a<p>
<b>Introduction: </b>Both cCTX/GCs and CNIs are recommended as first-line agents in the management of PMN. The present study is an extended report of patients randomized to receive TAC/GCs or cCTX/GCs at 2 years post randomization.
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<b>Methods: </b>Seventy patients enrolled in the clinical trial Tacrolimus Combined With Corticosteroids Versus Modified Ponticelli Regimen in Treatment of Idiopathic Membranous Nephropathy: Randomized Control Trial were followed quarterly between 12 and 24 months. At the end of 24 months, 3 patients were lost to follow-up.
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<b>Results: </b>At 18 months, 66% and 89% (P&nbsp;= 0.04) were in remission in TAC/GCs and cCTX/GCs groups, respectively. At 18 and 24 months, 60% and 86% (P&nbsp;= 0.03) of cases were in remission in the TAC/GCs and cCTX/GCs groups, respectively. At 18 months, 57% and 83% (P&nbsp;= 0.03) of the patients in TAC/GCs and cCTX/GCs groups were in remission without need of any additional immunosuppression (persistent remission) and, at 24 months, 43% and 80% (P&nbsp;= 0.002) were in persistent remission in TAC/GCs and cCTX/GCs groups, respectively. Relapse rate after any remission was 40% and 6.7% in TAC/GCs and cCTX/GCs groups, respectively (P&nbsp;= 0.007). There was an association of aPLA2R titers with remission or resistance (P&nbsp;= 0.006) in relapsing PMN. The significant decrease in eGFR after 12 months of TAC/GCs therapy normalized at 18 and 24 months.
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<b>Discussion: </b>At 2 years after randomization, relapse rates are higher for TAC/GCs compared with cCTX/GCs in PMN patients. Thus, cCTX/GCs are better than TAC/GCs in the longer term in PMN patients.
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