Leflunomide plus oral prednisone in treatment of idiopathic membranous nephropathy: A retrospective clinical study of efficacy and safety

Aim Treatment of idiopathic membranous nephropathy (IMN) remains a controversial issue. While clinical trials have shown that some immunosuppressants combined with glucocorticoid have a good efficacy on IMN patients. However, there is little data on leflunomide (LEF) in treatment of IMN. Methods Records of every patient with biopsy-proven IMN in Department of Nephrology, the First Affiliated Hospital, Xi'an Jiaotong University from January 2005 to December 2011 (n = 194) were retrospectively analyzed. Patients with nephrotic IMN were treated with LEF plus oral prednisone (n = 32) for at least 12 months, whereas 31 patients who did not receive any immunosuppressants were used as controls. Results Remission rates in the LEF group were 31.3%, 59.4%, 68.8% and 71.9% at 6, 9, 12 and 15 months, respectively, which were significantly higher than those in controls. In the LEF group, proteinuria decreased from 6.79 g/24 h at baseline to 5.63 g/24 h (P < 0.01), 3.85 g/24 h (P < 0.01) and 2.51 g/24 h (P < 0.01) after treatment for 6, 9 and 12 months, respectively. Relapse occurred in five (21.7%) patients within a median of 14 months (range, 8-27) after cessation of LEF. No patients developed renal insufficiency during the therapeutic period. Multivariate analysis suggested that age negatively correlated with achievement of remission (odds ratio, 0.87; P < 0.05). No serious adverse events were observed. Conclusion LEF plus oral prednisone may be an alternative treatment option in Chinese patients with nephrotic IMN. Summary at a Glance This retrospective study reports that leflunomide combined with oral prednisone is effective and safe to treat idiopathic membranous nephropathy with nephrotic syndrome.