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 D epartment of N ephrology, the F irst A ffiliated H ospital, X i'an J iaotong U niversity from J anuary 2005 to D ecember 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 C hinese patients with nephrotic IMN .