Safety and Efficacy of Combination ACTHar Gel and Tacrolimus in Treatment-Resistant Focal Segmental Glomerulosclerosis and Membranous Glomerulopathy

摘要: Introduction H.P. ACTHar gel is a preparation of melanocortin peptides that has been used to treat resistant forms nephrotic syndrome. To determine whether combination therapy with and tacrolimus reduces proteinuria stabilizes renal function, we conducted prospective, open-label trial in patients treatment-resistant membranous glomerulopathy (MGN) focal segmental glomerulosclerosis (FSGS). Methods Nine MGN 13 FSGS received subcutaneous for 6 months. Patients no response or partial alone an additional months oral tacrolimus. The study endpoint was the percentage achieving complete remission after therapy. Results Among MGN, treatment achieved 44% 56% patients. No patient alone. An resulted rates 25% 75%, respectively. FSGS, rate 7.7% 62.0%. Combination increased 17% responses 66%. Proteinuria (urinary protein-to-creatinine ratio) significantly reduced both those further among addition There were significant changes estimated glomerular filtration during phase long-term follow-up. Discussion well tolerated by improved clinical compared