Ponticelli C et al. (2006) A randomized pilot trial comparing methylprednisolone plus a cytotoxic agent versus synthetic adrenocorticotropic hormone in idiopathic membranous nephropathy. Am J Kidney Dis 47: 233–240

Treatment with methylprednisolone plus a cytotoxic drug improves remission rates and 10-year survival in patients with membranous nephropathy, but can have adverse effects. In patients with membranous nephropathy and nephrotic syndrome, Ponticelli and colleagues compared the safety and efficacy of treatment with methylprednisolone plus a cytotoxic agent with that of synthetic adrenocorticotropic hormone, which has lipid-lowering effects in healthy individuals.

In this multicenter, prospective, randomized pilot trial, patients with biopsy-proven membranous nephropathy were randomized to receive 3 cycles of 1 month of methylprednisolone followed by 1 month of a cytotoxic drug, or treatment with synthetic adrenocorticotropic hormone delivered intramuscularly twice weekly for 1 year. Remission as a first event was observed in 15/16 patients treated with methylprednisolone and in 14/16 patients treated with adrenocorticotropic hormone. There were no differences in the incidences of partial, complete or cumulative remissions achieved over the mean 24-month follow-up, or in the median time to response or the median decrease in proteinuria, between the two treatment groups. Treatment was terminated in two patients from each group because of adverse effects or lack of efficacy.

The authors conclude that both methylprednisolone plus a cytotoxic agent and synthetic adrenocorticotropic hormone safely relieve the symptoms of nephrotic syndrome associated with idiopathic membranous nephropathy. Larger randomized trials with longer follow-up are required to confirm these results.