Efficacy of mycophenolate treatment in adults with steroid-dependent/frequently relapsing idiopathic nephrotic syndrome
Por:
Sandoval, D, Poveda, R, Draibe, J, Perez-Oller, L, Diaz, M, Ballarin, J, Saurina, A, Marco, H, Bonet, J, Barros, X, Fulladosa, X, Torras, J, Cruzado, JM
Publicada:
1 oct 2017
Resumen:
Background: This study assessed the efficacy of therapy with mycophenolate (MF) and reduced doses of steroids in adults with steroid-dependent/frequently relapsing idiopathic nephrotic syndrome (SD/FR-INS).
Methods: Twenty-nine nephrotic patients (including 16 males and 13 females; mean age: 40 years, range: 18-74) were treated. Starting doses of MF were 2000 mg/day for mofetil MF (1500 mg/day in one patient) or 1440 mg/day for sodium MF. The initial prednisone (PDN) dose was 10 mg/day in 14 patients, 5 mg/day in two patients and no steroids in one patient. In the remaining 12 patients, moderate initial doses of PDN were administered (mean: 23.7 mg/day, range: 15-40), tapering to 10 mg/day after 1 month.
Results: Nephrotic syndrome remission was achieved in 27/29 cases (93.1%) (25 complete, 2 partial). Two patients showed resistance to the prescribed schedule. The first cycle of MF therapy was concluded in 20 patients after a mean (range) of 16.9 months (12-49). Maintenance of remission was observed in 11 of these 20 cases (55%) after a mean follow-up of 32.8 months (12-108). In nine patients with nephrotic syndrome relapse after tapering of MF (MF dependency), the same MF-PDN schedule was restarted, leading again to remission in all nine. The remaining seven MF-sensitive patients are still receiving their first therapeutic cycle. To date, the mean time under therapy in the 27 MF-sensitive patients is 38 months (4-216). Regarding complications, only minor digestive disorders and a slight decrease in blood haemoglobin levels were observed in a few patients.
Conclusions: MF plus reduced doses of PDN is an effective and well-tolerated therapy for adult SD/FR-INS. Though MF dependence is observed, its low toxicity could allow long periods of therapy if it is required to maintain nephrotic syndrome remission.
Filiaciones:
Sandoval, D:
Hosp Bellvitge Princeps Espanya, Dept Nephrol, Barcelona, Spain
Poveda, R:
Hosp Bellvitge Princeps Espanya, Dept Nephrol, Barcelona, Spain
Draibe, J:
Hosp Bellvitge Princeps Espanya, Dept Nephrol, Barcelona, Spain
Perez-Oller, L:
Hosp Gen Vic, Dept Nephrol, Vic, Catalunya, Spain
Diaz, M:
Fundacio Puigvert Barcelona, Renal & Hypertens Unit, Barcelona, Spain
Ballarin, J:
Fundacio Puigvert Barcelona, Renal & Hypertens Unit, Barcelona, Spain
Saurina, A:
Hosp Terrassa, Dept Nephrol, Terrassa, Catalunya, Spain
Marco, H:
Hosp Germans Trias & Pujol Badalona, Dept Dialysis, Barcelona, Spain
Bonet, J:
Hosp Germans Trias & Pujol Badalona, Dept Dialysis, Barcelona, Spain
Barros, X:
Hosp Josep Trueta Girona, Dept Nephrol, Girona, Catalunya, Spain
Fulladosa, X:
Hosp Bellvitge Princeps Espanya, Dept Nephrol, Barcelona, Spain
Torras, J:
Hosp Bellvitge Princeps Espanya, Dept Nephrol, Barcelona, Spain
Cruzado, JM:
Hosp Bellvitge Princeps Espanya, Dept Nephrol, Barcelona, Spain
Gold, Green Published
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