Comparison of efficacy and safety between tacrolimus and cyclosporine combined with corticosteroids in patients with idiopathic membranous nephropathy: a randomized controlled trial

Objectives: Immunosuppressive therapy plays an important role in patients with idiopathic membranous nephropathy (IMN). Evidence regarding the optimal kind of calcineurin inhibitors (CNIs) in treatment of IMN remains unclear. The objective of this study was to examine whether tacrolimus (TAC) is more effective and safe than cyclosporine (CsA) in treating IMN patients. Methods: We conducted a prospective randomized controlled study in 31 IMN patients, who were diagnosed by laboratory examination and renal biopsy. Among them, 16 patients received TAC combined with corticosteroids and 15 patients received CsA combined with corticosteroids. The follow-up period was 6 months. Results: After 6 months of therapy, no patient was lost to follow-up, complete remission (CR) occurred in 7 (43.8%) of the TAC group and 5 (33.3%) of the CsA group; partial remission (PR) occurred in 7 (43.8%) and 6 (40.0%) treated with TAC and CsA, respectively. The probability of remission (either CR or PR) was higher in the TAC group than in the CsA group, but there was no significant difference (p=0.116, by log-rank test). Furthermore, a greater incidence rate of hyperuricemia, new-onset hyperglycemia and hand tremor was observed in the TAC group compared with the CsA group. But the incidence rate of hypertrichosis, gingival hyperplasia was lower than that in the CsA group. Conclusion: TAC or CsA combined with corticosteroids was both useful for adults with IMN. But TAC was not inferior to CsA in efficacy. Otherwise, TAC and CsA had different side effects, so CNIs should be used in individualized way in patients with IMN.