Synthetic adrenocorticotropic hormone (ACTH) may be an effective way to reduce proteinuria and preserve kidney function in patients with idiopathic membranous nephropathy (MN), according to study findings presented at the National Kidney Foundation’s 2014 Spring Clinical Meetings in Las Vegas.
Anna-Lena Berg, MD, PhD, of Lund University in Lund, Sweden, presented 5-year follow-up data on 28 patients with idiopathic MN treated with ACTH. Patients had a mean age of 63 years (range 34-85 years). The median time from MN diagnosis to initiation of ACTH treatment was 9.5 months. All patients received standard of care, which included ACE inhibitors and angiotensin-receptor blockers, statins, and other symptomatic therapies. ACTH therapy was started at 1 mg per week and was increased to a maximum of 1 mg twice weekly. The median duration of therapy was 10 months (range 2-24 months). Investigators obtained follow-up data from 36-58 months after cessation of ACTH.
Data showed that urinary albumin decreased from a median of 4,381 mg/L before ACTH treatment to 270 mg/L after treatment and 89 mg/L at follow-up. Serum albumin increased from a median of 20 g/L before ACTH treatment to 35.5 g/L after treatment and 37 g/L at follow-up. In addition, estimated glomerular filtration rate increased from 56.5 mL/min/1.73 m2 before treatment to 62.5 mL/min/1.73 m2 after treatment.
Five years after the start of ACTH therapy, 19 patients had complete remission (proteinuria levels below 200 mg/L) and 8 patients had partial remission (proteinuria reduced by 50% to below 2,000 mg/L). The median eGFR for the cohort at 5 years remained improved compared with baseline (65 mL/min/1.73 m2).