J Nephropathol. 2019;8(3): e25.
doi: 10.15171/jnp.2019.25

Scopus ID: 85071835366
  Abstract View: 4586
  PDF Download: 1384

Original Article

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

Indu Ramachandra Rao 1 ORCID logo, Ravindra Prabhu Attur 1 ORCID logo, Dharshan Rangaswamy 1 ORCID logo, Srinivas Shenoy 1 ORCID logo, Sindhura Lakshmi Koulmane Laxminarayana 2 ORCID logo, Shankar Prasad Nagaraju 1* ORCID logo

1 Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
2 Department of Pathology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
*Corresponding Author: Email: shankarmmcmed@gmail.com


Background: 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.

Objectives: 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.

Patients and Methods: 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.

Results: 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).

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

Implication for health policy/practice/research/medical education:

Although the efficacy of the mPR is well-proven, it is associated with a high risk of serious adverse events. Whether lowering dose of intravenous pulse steroids would result in reduction of treatment-associated toxicity is unclear. In this retrospective study, we report the response to a lower-than-standard dose intravenous pulse steroid-based modification of the modified Ponticelli regimen (500 mg methylprednisolone, instead of the standard 1000 mg dose).

Please cite this paper as: Ramachandra Rao I, Prabhu Attur R, Rangaswamy D, Shenoy S, Laxminarayana SLK, Nagaraju SP. Efficacy and safety of a modified- “modified Ponticelli” regimen for treatment of primary membranous nephropathy. J Nephropathol. 2019;8(3):e25. DOI: 10.15171/jnp.2019.25.

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Submitted: 07 May 2018
Accepted: 18 Jul 2019
ePublished: 08 Aug 2019
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