Cyclosporine versus mycophenolate mofetil for maintenance of remission of steroid-dependent nephrotic syndrome after a single infusion of rituximab
| Autor: | Kazunari Kaneko, Shuichiro Fujinaga, Toshiaki Shimizu, Akira Ito, Yoshiyuki Ohtomo, Tsuneki Watanabe, Tomonosuke Someya |
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| Rok vydání: | 2012 |
| Předmět: |
Male
medicine.medical_specialty Nephrotic Syndrome Adolescent Urology Kaplan-Meier Estimate Pharmacology Mycophenolate Mycophenolic acid Maintenance Chemotherapy Antibodies Monoclonal Murine-Derived Maintenance therapy Secondary Prevention medicine Humans Immunologic Factors Prospective Studies Child Prospective cohort study business.industry Steroid-dependent nephrotic syndrome Mycophenolic Acid medicine.disease Treatment Outcome Pediatrics Perinatology and Child Health Monoclonal Cyclosporine Female Steroids Rituximab business Nephrotic syndrome Immunosuppressive Agents medicine.drug |
| Zdroj: | European Journal of Pediatrics. 172:513-518 |
| ISSN: | 1432-1076 0340-6199 |
| DOI: | 10.1007/s00431-012-1913-3 |
| Popis: | The efficacy of rituximab (RTX) as the sole therapy for preventing relapses of nephrotic syndrome (NS) is transient in most patients; therefore, the optimal therapy required for maintaining a successful response to a biological agent remains a challenge. We conducted a prospective study to compare the efficacy of cyclosporine (CsA) with that of mycophenolate mofetil (MMF) as maintenance therapy after a single infusion of RTX. Of 29 patients with persistent steroid-dependent NS despite the use of CsA and/or MMF, 13 without chronic nephrotoxicity continued CsA therapy, maintaining a 2-h post-dose CsA level of 400–500 ng/ml (CsA group). The remaining 16 were treated with MMF, maintaining a pre-dose level of 2–5 μg/ml of mycophenolic acid (MMF group). The median duration of CsA and MMF treatment was 18 and 19 months, respectively. Despite the mean number of relapses before RTX treatment being significantly lower in the MMF group than in the CsA group (2.3/year vs. 4.6/year, p < 0.01), treatment failure occurred more frequently in the MMF group (7/16) than in the CsA group (2/13). The rate of sustained remission was also significantly higher in the CsA group than in the MMF group (p < 0.05). Conclusion: In patients with severe steroid-dependent NS, CsA appears to be more effective than MMF for maintaining remission after a single infusion of RTX. |
| Databáze: | OpenAIRE |
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