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

Background: Patients with primary membranous nephropathy may progress to advanced chronic kidney disease despite immunosuppressive therapy (IST). 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 IST-induced early changes in standard clinical markers predicted clinical remission at 2 years. The 2-year primary outcome was complete (CR) or partial remission (PR). The secondary outcome was CR. Additionally, we described kidney function outcomes. Standard clinical markers were incorporated into statistical modeling by logistic regression. Predictive performance was assessed by receiver operating characteristic curve analysis.

Results: The best multivariate model excluding immunosuppression to predict complete or PR at 2 years, included 3-month 24-h proteinuria, serum creatinine and immunological response [area under the curve (AUC) 0.87, 95% confidence interval (CI) 0.76-0.94, efficiency 87%]. For CR 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 IST predicted clinical remission at 2 years with significantly better predictive performance than baseline data or each clinical marker assessed separately.