Identification of early predictors of clinical remission in primary membranous nephropathy: a post-hoc analysis of the STARMEN trial

Abstract Background Patients with primary membranous nephropathy may progress to advanced chronic kidney disease despite immunosuppressive therapy. Prediction of treatment response based on early and combined assessment of several standard clinical markers could improve risk stratification for progression, allowing timely individualization of treatment, which can optimize clinical outcomes and safety. Methods In this post-hoc exploratory analysis of the STARMEN trial, we evaluated if combined baseline data, and immunosuppressive therapy-induced early changes in standard clinical markers predicted clinical remission at 2-years. The 2-years primary outcome was complete or partial remission. The secondary outcome was complete remission. Additionally, we described kidney function outcomes. Standard clinical markers were incorporated into statistical modeling by logistic regression. Predictive performance was assessed by ROC curve analysis. Results The best multivariate model excluding immunosuppression to predict complete or partial remission at 2 years, included 3-months 24h-proteinuria, serum creatinine and immunological response (AUC:0.87, 95%CI:0.76–0.94, efficicency 87%). For complete remission at 2 years, the best model included the same clinical markers at 6 months, but predictive performance was lower (AUC:0.74, 95%CI:0.62–0.85, efficiency 70%). Conclusions In the STARMEN cohort, a multivariable model that included 24-h proteinuria, serum creatinine, and immunological response status at 3 months after initiation of immunosuppressive therapy predicted clinical remission at 2 years with significantly better predictive performance than baseline data or each clinical marker assessed separately.