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Background: Idiopathic membranous nephropathy(IMN)is a major cause of nephrotic syndrome among adults.Given the special nature course of IMN,when to treat and with which immunosuppressive treatment needed to be seriously considered.Tripterygium wilfordii multiglycosides(TWG)combined with prednisone may provide an effective option to treat patients in IMN.Methods: This prospective cohort study included patients with biopsy-proven IMN in our kidney center.One cohort received TWG combined with prednisone and the other cohort received tacrolimus(TAC)combined with prednisone for 36 weeks.Primary outcome included remission rate.Secondary outcomes included the time to remission,relapse rate,changes in serum albumin and daily proteinuria,estimated glomerular filtration rate(eGFR)and adverse events.Results: 53 patients with IMN met criteria for enrollment and all patients completed the therapy.The results of the 36-week therapeutic period were remission(either PR or CR)of 20 patients(86.9%)on TWG and 27 patients(90.0%)on TAC(p>0.05),complete remission(CR)of 12 patients(52.2%)on TWG and 14 patients(46.7%)on TAC(p>0.05).The probability of remission was similar for both the TWG and TAC groups(p>0.05,by log-bank test).The mean time for achieving remission was 11.8±12.5 weeks in the TWG group and 8.5±9.1 weeks in the TAC group(p>0.05).Conclusions: Tripterygium wilfordii multiglycosides combined with predisone was an effective and safe therapy for IMN.