<![CDATA[Background: Primary membranous nephropathy (MN) is a leading cause of the nephrotic syndrome in adults. Calcineurin inhibitor (CNI)-based and cyclophosphamide-based regimens are both endorsed as first-line therapy, but their comparative efficacy and the durability of the remission they induce remain uncertain. Objective: To compare CNI-based versus cyclophosphamide-based regimens for total remission, complete remission and relapse in adults with primary MN. Methods: PubMed/MEDLINE, with Scopus and Web of Science indexing checks and manual reference screening, was searched for randomised controlled trials comparing a CNI-based regimen (tacrolimus or cyclosporine) with a cyclophosphamide-based regimen. Risk ratios (RRs) were pooled with a DerSimonian–Laird random-effects model; heterogeneity was quantified with I²; risk of bias used the Cochrane RoB 2 tool. Results: Nine RCTs (eleven articles; 599 participants) were included. Total remission did not differ between strategies (RR 1.02, 95% CI 0.86–1.20; I²=67%; 95% prediction interval 0.61–1.72). Complete remission did not differ (RR 0.84, 95% CI 0.34–2.04). Relapse tended to be more frequent after CNI-based therapy (RR 1.76, 95% CI 0.95–3.24; I²=0%) without reaching significance. Estimates were stable across all sensitivity analyses, and no small-study effect was detected (Egger p=0.87). Conclusion: CNI-based and cyclophosphamide-based regimens produced comparable remission in primary MN; a non-significant signal towards more frequent relapse after CNI therapy supports individualised, durability- and toxicity-aware treatment selection.]]>
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