B BOSE 1,2, S BADVE 2,3,4, D JOHNSON 2,5,6, C HAWLEY 2,5,6, V JHA 7,8,9, D REIDLINGER 2, C PEH 10
1Department of Nephrology, Nepean Hospital, Kingswood, Australia, 2Australasian Kidney Trials Network, The University of Queensland, Brisbane, Australia, 3Department of Nephrology, St George Hospital, Sydney, Australia, 4The George Institute for Global Health, University of New South Wales Medicine, Sydney, Australia, 5Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia, 6Translational Research Institute, Brisbane, Australia, 7George Institute of Global Health, New Delhi, India, 8School of Public Health, Imperial College , London, UK, 9Manipal Academy of Higher Education, Manipal, India, 10Royal Adelaide Hospital and the University of Adelaide, Adelaide, Australia
Aim: To ascertain prevailing views among nephrologists on their choice of immunosuppressive agents used to treat this disease.
Background: There are different treatment strategies available for treating patients with primary membranous nephropathy, and there is no clear consensus on how best to treat these patients
Methods: The Australasian Kidney Trials Network conducted a multinational online survey among nephrologists from the Asia-Pacific region to identify prescribing practices to treat primary membranous nephropathy. Survey questions focused on the types of immunosuppressive therapies used, preferred first-line and second-line therapies, indications for starting immunosuppressive therapy, the preferred mode of combining corticosteroid and cyclophosphamide, the use of serum phospholipase A2 receptor antibody testing in clinical practice, indications for anticoagulation, and interest in participating in future clinical trials in primary membranous nephropathy.
Results:157 nephrologists from 9 countries responded to the online survey. The majority of them were senior nephrologists from Australia and India with significant experience in managing patients with primary membranous nephropathy. The combination of cyclophosphamide and corticosteroid was the preferred first-line therapy. Of those who used this combination, only 34.3% followed the Kidney Disease Improving Global Outcomes (KDIGO) 2012 guidelines by adding intravenous methylprednisolone. The combination of calcineurin inhibitor with corticosteroid was the most common second-line therapy. The majority of respondents considered prophylactic anticoagulation if serum albumin was less than 25gm/L.
Conclusion: The combination of corticosteroid with cyclophosphamide (without intravenous methylprednisolone) is the most commonly reported first-line immunosuppressive therapy for the management of primary membranous nephropathy.
Dr Bhadran Bose is a Renal Staff Specialist at Nepean and Blue Mountains hospital and is also a clinical lecturer with the University of Sydney. He has special interests in glomerular diseases. He completed his Nephrology training at the Princess Alexandra Hospital, Brisbane. Dr Bose then did a year of post-FRACP fellowship at the University of Toronto, Canada on glomerular disorders and pregnancies in patients with renal disorders.
He has published original research and narrative review in international nephrology journals has co-authored chapters in textbooks. He is actively involved in research and teaching.