***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Although idiopathic membranous nephropathy ( IMN ) is the most common cause of adult-onset nephrotic syndrome , the management of IMN remains controversial . The aim of this prospect i ve study was to compare the efficacy and drug safety of tacrolimus with that of cyclophosphamide ( CTX ; control group ) in IMN patients receiving corticosteroid therapy .  A total of 100 IMN patients with nephrotic syndrome were r and omly assigned to receive a combination of corticosteroid therapy and either CTX or tacrolimus . During a follow-up period of at least 18 months , the remission rate after 2 months in the tacrolimus group was 65.1 % , which was higher than that of the CTX group ( 44.2 % ) ( p = 0.02 ) . The mean time to partial or complete remission was 2.20 months in the tacrolimus group and 3.92 months in the CTX group ( p < 0.001 ) . We also found significantly greater improvements in the serum albumin levels in the tacrolimus group compared with the CTX group at the 2-month ( p = 0.003 ) and 3-month time points ( p = 0.01 ) . The serum creatinine levels remained stable in both groups . Although remission was quicker and more common in the tacrolimus group ( compared with the CTX group ) before 3 months , there was no superiority of tacrolimus after 6 months . Glucose intolerance , urinary tract infections , and pneumonia were the major side effects observed in this study . All of the side effects were mild and controlled , and there were fewer side effects in the tacrolimus group compared with the CTX group , indicating a better treatment tolerance in the tacrolimus group BACKGROUND Evidence regarding the optimal dose of tacrolimus ( TAC ) in treatment of idiopathic membranous nephropathy ( IMN ) remains inconclusive . The objective of this study was to evaluate the efficacy and safety of low-dose TAC combined with prednisone for patients with IMN . METHODS We conducted a r and omized prospect i ve cohort study in IMN patients : 28 patients received oral TAC  ( target whole blood concentration of 2 - 4 ng/mL ) plus prednisone for 12 months , and 28 patients received prednisone combined with intravenous cyclophosphamide ( CYC )  ( 750 mg/m2 body surface ) once every 4 weeks for 24 weeks . RESULTS Of the 56 patients who completed the 12-month treatment , complete remission ( CR ) occurred in 8 ( 28.6 % ) of the CYC group and 18 ( 64.3 % ) of the TAC group ; partial remission ( PR ) occurred in 10 ( 35.7 % ) of the CYC group and 7 ( 25.0 % ) of the TAC group . The probability of remission ( either CR or PR ) was higher in the TAC group than in the CYC group ( p = 0.0439 , by log-rank test ) . Furthermore , a significantly greater improvement in proteinuria and serum albumin levels was observed in the TAC group compared with the CYC group . Patients treated with TAC can often show a rapid increase in their serum albumin levels before any obvious reduction of urinary protein excretion . Side effects were mild and transitory in both groups . CONCLUSION The results demonstrated that the combined therapy of low-dose TAC and prednisone is an effective and safe therapeutic method for Chinese adults with IMN . Low-dose TAC accompanied by prednisone is enough to induce remission in the majority of patients with IMN BACKGROUND Calcineurin inhibitors are the most commonly used immunosuppressive drugs in liver transplantation , but the optimum initial immunosuppression regimen is not known . The aim of our study was to compare tacrolimus with microemulsified ciclosporin , in a regimen with st and ardised concomitant immunosuppressive therapy . METHODS In all liver transplant centres in the UK and Republic of Irel and , 606 patients undergoing a first orthotopic liver transplantation were r and omly assigned open-label tacrolimus or microemulsified ciclosporin . Primary outcome was the combined frequency ( whichever occurred first ) of death , retransplantation , or treatment failure for immunological reasons , analysed by intention to treat . FINDINGS 96 % of patients received the treatment allocated to them . The primary outcome was reached in 62 ( 21 % ) of 301 patients in the tacrolimus group versus 99 ( 32 % ) of 305 allocated microemulsified ciclosporin ( relative risk 0.63 [ 95 % CI 0.48 - 0.84 ] , p=0.001 ; time-to-event analysis log-rank test p=0.002 ) : deaths ( 50 [ 17 % ] vs 72 [ 24 % ] ) ; retransplantations ( 11 [ 4 % ] vs 31 [ 10 % ] ) treatment failure for immunological reasons ( 6 [ 2 % ] vs 12 [ 4 % ] ) . The relative risk for the composite outcome was in favour of tacrolimus . The main causes of death in both trial groups were sepsis and multiple organ failure ( 31 [ 10 % ] vs 30 [ 10 % ] ) , and the main cause for retransplantation was hepatic artery thrombosis ( 6 [ 2 % ] vs 17 [ 6 % ] ) . Renal dysfunction and the need for antihypertensive therapy were much the same in both groups . Tacrolimus was more diabetogenic . INTERPRETATION Clinical outcome at 1 year was better with tacrolimus-based immunosuppression than with microemulsified ciclosporin during the first year after liver transplantation . Tacrolimus should be the first choice of calcineurin inhibitor for patients receiving their first liver graft BACKGROUND AND OBJECTIVES Cyclophosphamide treatment improves renal survival in patients with idiopathic membranous nephropathy . However , use of cyclophosphamide is associated with cancer . The incidence of malignancies in patients with idiopathic membranous nephropathy was evaluated , and the cancer risk associated with cyclophosphamide use was estimated . DESIGN , SETTING , PARTICIPANTS , & MEASUREMENTS Patients who attended the clinic were included prospect ively from 1995 on . A crude incidence ratio for the occurrence of malignancy was calculated . Incidence ratios were subsequently st and ardized to potential confounders . Latency between cyclophosphamide therapy and the occurrence of cancer was estimated by stratifying for time since the start of treatment . Finally , Poisson regression was used to obtain a multiple adjusted incidence ratio and investigate the dose-response relationship between cyclophosphamide and cancer . RESULTS Data were available for 272 patients ; the mean age was 51 years , and 70 % of the patients were men . Median follow-up was 6.0 years ( interquartile range=3.6 - 9.5 ) , and 127 patients were treated with cyclophosphamide .  Cancer incidence was 21.2 per 1000 person-years in treated patients compared with 4.6 per 1000 person-years in patients who did not receive cyclophosphamide  , result ing in crude and adjusted incidence ratios of 4.6 ( 95 % confidence interval , 1.5 to 18.8 ) and 3.2 ( 95 % confidence interval , 1.0 to 9.5 ) , respectively . CONCLUSION Cyclophosphamide therapy in idiopathic membranous nephropathy gives a threefold increase in cancer risk . For the average patient , this finding translates into an increase in annual risk from approximately 0.3 % to 1.0 % . The increased risk of malignancy must be balanced against the improved renal survival BACKGROUND To examine whether tacrolimus is more effective and safe than cyclosporine ( CsA ) in inducing remission in patients with steroid-resistant nephrotic syndrome ( SRNS ) . STUDY DESIGN R and omized controlled trial , nonblind , parallel group . SETTING S & PARTICIPANTS Tertiary-care hospital ; 41 consecutive patients with idiopathic SRNS , estimated glomerular filtration rate greater than 60 mL/min/1.73 m(2 ) , and histological characteristics showing minimal change disease , focal segmental glomerulosclerosis , or mesangioproliferative glomerulonephritis were r and omly assigned to treatment with  tacrolimus ( n = 21 ) or CsA ( n = 20 ) . INTERVENTION Tacrolimus ( 0.1 to 0.2 mg/kg/d ) or CsA ( 5 to 6 mg/kg/d ) for 1 year ; cotreatment with alternate-day prednisolone and enalapril . OUTCOMES Patients achieving complete remission ( urinary protein-creatinine ratio < 0.2 g/g and serum albumin > or = 2.5 g/dL ) or partial remission ( urinary protein-creatinine ratio , 0.2 to 2 g/g , and serum albumin > or = 2.5 g/dL ) at 6 and 12 months ; time to remission ; proportion with relapses ; side effects . RESULTS No patient was lost to follow-up . After 6 months of therapy , remission occurred in 18 ( 85.7 % ) and 16 patients ( 80 % ) treated with tacrolimus and CsA , respectively ( relative risk [ RR ] , 1.07 ; 95 % confidence interval [ CI ] , 0.81 to 1.41 ) . Rates of remission at 12 months were also similar ( RR , 1.14 ; 95 % CI , 0.84 to 1.55 ) . The proportion of patients who experienced relapse was significantly greater in those receiving CsA compared with tacrolimus ( RR , 4.5 ; 95 % CI , 1.1 to 18.2 ; P = 0.01 ) . The decrease in blood cholesterol levels was greater with tacrolimus compared with CsA ( difference in mean values , 45.1 mg/dL ; 95 % CI , 19.1 to 71.2 ) . Persistent nephrotoxicity necessitating stoppage of medicine was seen in 4.7 % and 10 % patients , respectively . Cosmetic side effects ( hypertrichosis and gum hypertrophy ) were significantly more frequent in CsA-treated patients ( P < 0.001 ) . LIMITATIONS Single-center study , small sample size , and short duration of follow-up . CONCLUSIONS Tacrolimus or CsA in combination with low-dose steroids show similar efficacy in inducing remission in patients with SRNS . Therapy with tacrolimus is a promising alternative to CsA in view of the lower risk of relapses and lack of cosmetic side effects BACKGROUND Membranous nephropathy is a common cause of nephrotic syndrome ( NS ) in adults . Its treatment is still under debate . METHODS We report our experience in a pilot study using initially low doses of steroids and tacrolimus ( Tac ) . After 3 months of treatment , mycophenolate mofetil ( MMF ) was added if the proteinuria was higher than 1 g/day . RESULTS In accordance with this st and ard , 21 patients entered the study . A proteinuria level lower than 1 g/day was reached at month 3 of therapy with steroids and Tac in 11 patients . These patients continued this treatment for 12 months . MMF was added in nine cases after the third month and triple therapy was maintained for 12 more months . Two patients were withdrawn because of side effects . At the end of the treatment , remission of the NS was present in 15 out of all the patients ( 71.4 % ) . Remission of the NS was complete in eight ( 53.3 % ) patients and partial in seven ( 46.7 % ) others . The remaining four patients did not respond . There were no significant changes in renal function . At a mean time of 23.1 months after treatment was discontinued , 11 ( 73.3 % ) patients had relapsed . CONCLUSIONS In this trial , treatment with tacrolimus showed a good efficacy but a high relapse rate when it was discontinued Membranous nephropathy is a common cause of nephrotic syndrome in adults . Although some patients with membranous nephropathy achieve a spontaneous remission , renal function continues to deteriorate in others . We conducted a prospect i ve r and omized trial evaluating monotherapy with tacrolimus to achieve complete or partial remission in patients with biopsy-proven membranous nephropathy . Twenty-five patients received tacrolimus ( 0.05 mg/kg/day ) over 12 months with a 6-month taper , whereas 23 patients were in the control group . The probability of remission in the treatment group was 58 , 82 , and 94 % after 6 , 12 , and 18 months but only 10 , 24 , and 35 % , respectively in the control group . The decrease in proteinuria was significantly greater in the treatment group . Notably , six patients in the control group and only one in the treatment group reached the secondary end point of a 50 % increase in their serum creatinine . No patient in the tacrolimus group showed a relapse during the taper period . Nephrotic syndrome reappeared in almost half of the patients who were in remission by the 18th month after tacrolimus withdrawal . We conclude that tacrolim 
    Output:
    
The cyclophosphamide group had a significantly higher risk of leukopenia , whereas the tacrolimus group had significantly higher rates of tremor .