NDT Advance Access originally published online on October 1, 2007
Nephrology Dialysis Transplantation 2008 23(6):1919-1925; doi:10.1093/ndt/gfm637
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Tacrolimus as a steroid-sparing agent for adults with steroid-dependent minimal change nephrotic syndrome
Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, #79 Qingchun Road, Hangzhou, Zhejiang Province 310003, People's Republic of China
Correspondence and offprint requests to: Jianghua Chen, Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, #79 Qingchun Road, Hangzhou, Zhejiang Province 310003, People's Republic of China. Tel: +86-571-87236992; Fax: +86-571-87236992; E-mail: chenjianghua{at}zju.edu.cn
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Abstract |
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Background. Treatment of adults with steroid-dependent minimal change nephrotic syndrome (SD-MCNS) can be a significant challenge. Cyclophosphamide (CYC) and cyclosporin (CYA) are often effective steroid-sparing agents. Tacrolimus (TAC) may be another treatment option.
Methods. This open, prospective cohort study enrolled Chinese adults with SD-MCNS. At the start of the study, we administered TAC or intravenous CYC together with prednisone (0.5 mg/kg/day), the dose of which was tapered off throughout the study. The TAC cohort received oral TAC (target trough blood level of 4–8 ng/ml) for 24 weeks and the CYC cohort received intravenous CYC (750 mg/m2 body surface) once every 4 weeks for 24 weeks.
Results. Twenty-six patients met the criteria for enrollment (14 patients in the CYC group and 12 patients in the TAC group). One patient from each group discontinued treatment because of a drug-related side effect. Complete remission (CR) after the 24-week therapeutic period was 76.9% (10/13) in the CYC group and 90.9% (10/11) in the TAC group. The mean time required for CR in the TAC group was significantly less than in the CYC group (P = 0.031). Eight of 13 (61.5%) patients in the CYC group and 8 of 11 (72.7%) patients in the TAC group successfully stopped steroids and changed their status from steroid dependence. Sixty percent (6/10) of the CYC patients and 50% (5/10) of the TAC patients who achieved CR maintained remission during the follow-up period of 23.0 ± 10.1 months. Four (40%) CYC patients and five (50%) TAC patients experienced relapses, and two CYC patients experienced frequent relapses.
Conclusion. A 24-week course of TAC is a favorable steroid-sparing agent for treatment of Chinese adults with SD-MCNS. Therapy with TAC accompanied by a tapering dose of prednisolone appears to yield quicker remission than treatment with CYC together with prednisone.
Keywords: adults; intravenous cyclophosphamide; minimal change nephrotic syndrome; steroid dependence; tacrolimus
Received for publication: 18. 4.07
Accepted in revised form: 21. 8.07