Correction

doi:10.2215/CJN.07190717

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Table 6.

Summary of the most common IST protocols for treating patients with primary membranous nephropathy (56–60,93)

IST Regimen	Drug, Dose	Comments
Cytotoxic drugs		KDIGO first choice
Modified Ponticelli	Months 1, 3, 5: 1 g methylprednisolone iv on days 1, 2, and 3 followed by oral prednisone, 0.5 mg/kg daily for 27 d	Monitor Uprotein and WBC weekly ×8, then every 2 mo; daily oral prednisone and cyclophosphamide may have similar efficacy. Increased risk of malignancy above 36 g
Modified Ponticelli	Months 2, 4, 6: 2.0–2.5 mg/kg oral cyclophosphamide daily	Relapse rate 20%–30%
Dutch protocol	Months 1, 3, 5: 1 g MP days 1–3 followed by oral prednisone, 0.5–1.0 mg/kg for 6 mo, then taper	Same as above
Dutch protocol	Oral cyclophosphamide, 1.5–2.0 mg/kg daily for 12 mo	Same as above
CNIs		KDIGO second choice
Cyclosporin	3.5–5.0 mg/kg daily in divided doses adjusted to level of 120–200 μg/L for 12–18 mo and tapered	Used in patients resistant to cytotoxic drugs but can be used as initial therapy. Taper slowly
	Prednisone 5–10 mg daily or alt days	Discontinue at 6 mo if no response
	Prednisone 5–10 mg daily or alt days	Relapse rate 40%–50%
Tacrolimus	0.05–0.075 mg/kg daily in two divided doses adjusted to level of 3–5 μg/L for 12–18 mo and taper slowly	Same as above
Tacrolimus	Prednisone 5–10 mg/kg per day daily or alt days	Preferable in young women
B cell depletion		Used for patients resistant to cytotoxic drugs or CNIs
B cell depletion		Utility as initial therapy not yet established by RCTs
Rituximab	375 mg/M² weekly times 4	Follow CD20 counts and repeat dose if counts rise before remission in proteinuria or relapse occurs
	375 mg/M² once and follow CD20 counts
	1000 mg on days 1 and 15
ACTH
Tetracosactrin (Synacthen) (synthetic)	1 mg IM every 2 wk for 6–12 mo
Corticotropin (ACTHAR) (purified)	80 U IM every 2 wk for 6–12 mo

IST, immunosuppressive therapy; KDIGO, Kidney Disease Improving Global Outcomes; WBC, white blood cells; MP, methylprednisolone; CNI, calcineurin inhibitor; alt, alternate; RCT, randomized controlled trial; ACTH, adrenocorticotrophic hormone; IM, intramuscular.