NDT Advance Access originally published online on September 12, 2006
Nephrology Dialysis Transplantation 2006 21(11):3127-3132; doi:10.1093/ndt/gfl360
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Induction and long-term treatment with cyclosporine in membranous nephropathy with the nephrotic syndrome
1Department of Nephrology and 2Department of Pathology, Hippokration General Hospital, Thessaloniki, Greece
Correspondence and offprint requests to: E. Alexopoulos, MD, Department of Nephrology, Hippokration General Hospital, 49, Konstantinoupoleos str., 54642 Thessaloniki, Greece. Email: nephrol{at}med.auth.gr
Background. Cyclosporine A (CyA) has been shown to be effective in membranous nephropathy (MN). However, the optimal dose and the duration of treatment remain controversial issues. We evaluated the efficacy of low-dose CyA alone or combined with corticosteroids as induction and long-term treatment for nephrotic patients with MN.
Methods. In the first part of the study, 51 nephrotic patients with MN were treated either with CyA and prednisolone (n = 31) or CyA alone (n = 20) for 12 months. Patients who responded with complete remission (CR) or partial remission (PR) were placed on long-term treatment with lower doses of CyA and prednisolone or CyA alone. The mean follow-up of the second part of the study was 26 ± 16 months and 18 ± 7 months, respectively.
Results. After 12 months of treatment, 26 patients in the combination group and 17 patients in the monotherapy group had a CR or PR of proteinuria (P = NS). Renal function was unchanged in the two groups. During long-term treatment relapses were more frequent in the monotherapy group (47 vs 15%, P < 0.05). Daily CyA dose was higher in non-relapsers in both groups (combination 1.4 ± 0.5 vs 1.0 ± 0.3 mg/kg, P < 0.001, monotherapy 1.5 ± 0.4 vs 1.1 ± 0.2 mg/kg, P < 0.003). Relapsers in both groups had lower CyA trough levels (72 ± 48 ng/ml) compared with non-relapsers (194 ± 80 ng/ml) (P < 0.03). Renal function and proteinuria remained stable during the follow-up.
Conclusion. This study suggests that 12-month therapy with CyA (±prednisolone) is effective in inducing remission in most nephrotic patients with MN and well-preserved renal function. Longer treatment with lower doses is a useful approach to maintain remission. Relapses occur more frequently in the monotherapy group and usually are associated with CyA trough levels <100 ng/ml.
Keywords: cyclosporine; membranous nephropathy; nephrotic syndrome; relapse; remission; trough levels of cyclosporine
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