Factors Influencing Choice of Treatment in Idiopathic Membranous Nephropathy
Public Deposited- Last Modified
- January 28, 2020
- Creator
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Mahoney, Shannon
- Affiliation: Gillings School of Global Public Health, Public Health Leadership Program
- Abstract
- Background The treatment of patients with IMN may include immunomodulation in patients resistant to conservative therapy alone, or perceived at high risk of progression. This study assesses the factors influencing the decision to treat with immunomodulators and the choice of treatment between alkylating agents and calcineurin inhibitors (CNI). Methods An inception cohort of 720 adults with biopsy-proven IMN (from 1976-2005) was derived from the Glomerular Disease Collaborative Network (N=328) and the Toronto Glomerulonephritis Registry (N=392). Subjects were allocated to groups based on initial treatment: no immunotherapy, alkylating agents, CNI, glucocorticoids (GC) only, or other immunosuppressant. The second treatment was considered in patients who initially received GC alone. Factors influencing decision to treat were analyzed using logistic regression, and those influencing choice of treatment by multinomial logit. Results Serum albumin and proteinuria were significantly different between those treated (66.3%) and those not treated (33.7%). Patients with a serum albumin of 2.5 mg/dL were more likely to be treated (OR 1.88, p=0.007, 95% CI [1.19,2.98]), as were those with greater 24 hour proteinuria (OR 1.12 for each 1g/day increase,p=0.001, 95% CI [1.06,1.18]). Patients in the TGNR were less likely to be treated than those in the GDCN (OR 0.45, p=0.001, 95% CI [0.28,0.72]). Of the factors analyzed with regards to choice of treatment, only sex was significant. Females were 3.49 times more likely to receive a calcineurin inhibitor than an alkylating agent (p=0.011, 95% CI [1.33,9.20]). Changes in choice of first therapy were observed over time. GC alone was the predominant approach until about 1994, at which time alkylating agents became the predominant choice. CNI were used in a minority of patients. Discussion Serum albumin, proteinuria, and registry were the only independent determinants of the decision to treat with immunomodulators. Sex was the only factor associated with the specific choice of therapy between alkylating agents and CNI; however, the sample size of those treated may have been too small to detect differences.
- Date of publication
- August 2011
- DOI
- Resource type
- Rights statement
- In Copyright
- Note
- Track: HC&P
- Advisor
- Nachman, Patrick
- Degree
- Master of Public Health
- Degree granting institution
- University of North Carolina at Chapel Hill
- Graduation year
- 2011
- Language
- Deposit record
- b6f6bdeb-f0b9-4907-a2ad-769b5d2e1080
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