{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T12:33:35Z","timestamp":1778934815873,"version":"3.51.4"},"reference-count":54,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2015,4,17]],"date-time":"2015-04-17T00:00:00Z","timestamp":1429228800000},"content-version":"vor","delay-in-days":16,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2015,4]]},"abstract":"<jats:p>Membranous nephropathy is one of the leading causes of nephrotic syndrome in adults, which is characterized by edema, hypoalbuminemia, hyperlipidemia, lipiduria, and proteinuria. Determination of idiopathic membranous nephropathy (<jats:styled-content style=\"fixed-case\">IMN<\/jats:styled-content>) disease progression risk is important for guiding initial therapy, with immunosuppressive therapy being reserved for high\u2010risk patients. Because <jats:styled-content style=\"fixed-case\">IMN<\/jats:styled-content> may spontaneously remit in approximately 30% of patients, it is important to carefully select which patients should begin immunosuppressive therapy so as to maximize clinical benefit while limiting toxicity. An observation period of at least 6\u00a0months with conservative management that includes the use of angiotensin\u2010converting enzyme inhibitors or angiotensin receptor blockers is recommended. Initial treatment in high\u2010risk <jats:styled-content style=\"fixed-case\">IMN<\/jats:styled-content> is a 6\u2010month course of alternating steroids and alkylating agents. Calcineurin inhibitors (<jats:styled-content style=\"fixed-case\">CNI<\/jats:styled-content>s) represent an alternative first\u2010line therapeutic option for high\u2010risk patients who refuse treatment with steroid or alkylating agent therapy or for whom these treatments are contraindicated. Additional options are essential for patients with <jats:styled-content style=\"fixed-case\">IMN<\/jats:styled-content> who fail to adequately respond to initial therapies or who cannot use recommended therapies due to contraindications or intolerance, risks associated with repetitive dosing with alkylating agents, or potential exacerbation of impaired renal function with <jats:styled-content style=\"fixed-case\">CNI<\/jats:styled-content>s. While evidence for the use of alternative therapies in <jats:styled-content style=\"fixed-case\">IMN<\/jats:styled-content> is modest at best, our review summarizes the available literature for rituximab, mycophenolate mofetil, adrenocorticotropic hormone, intravenous immunoglobulin, and azathioprine. Rituximab has generally demonstrated beneficial outcomes with limited toxicity. Evidence supports a role for mycophenolate mofetil, although the evidence is of low quality and limited duration. Results from ongoing studies are required before adrenocorticotropic hormone can be recommended as therapy for treatment\u2010resistant patients. Intravenous immunoglobulin and azathioprine are unlikely to have a role in <jats:styled-content style=\"fixed-case\">IMN<\/jats:styled-content>. With the advent of new tools and biomarkers measuring disease activity combined with new data regarding possible treatment options, the management and prognosis of <jats:styled-content style=\"fixed-case\">IMN<\/jats:styled-content> are likely to improve.<\/jats:p>","DOI":"10.1002\/phar.1575","type":"journal-article","created":{"date-parts":[[2015,4,17]],"date-time":"2015-04-17T07:37:30Z","timestamp":1429256250000},"page":"396-411","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Overview of Current and Alternative Therapies for Idiopathic Membranous Nephropathy"],"prefix":"10.1002","volume":"35","author":[{"given":"Tran H.","family":"Tran","sequence":"first","affiliation":[{"name":"College of Pharmacy and Health Sciences St. John's University Queens New York"},{"name":"NewYork\u2010Presbyterian Hospital\/Columbia University Medical Center New York New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gregory","family":"J. 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