Efficacy of Cyclophosphamide versus Cyclosporine in Frequent Relapse Nephrotic Syndrome – A Hospital Based Study
Journal of Pediatric Nephrology,
Vol. 4 No. 2 (2016),
4 July 2016
,
Page 60-64
https://doi.org/10.22037/jpn.v4i2.11716
Abstract
Introduction: The clinical outcome of patients with Frequent Relapse Nephrotic Syndrome (FRNS) or Steroid Dependent Nephrotic Syndrome (SDNS) treated with cyclophosphamide or cyclosporine (CsA) is yet to be established. This study was carried out to compare the efficacy of CsA with cyclophosphamide in patients with FRNS or SDNS.
Materials and Methods: A total of 54 FRNS or SDNS children were randomly enrolled in this prospective study from August 2013 to July 2014. All the study subjects were treated with prednisolone 60 mg/m2 /day until the patients were in remission for three consecutive days. The patients were then randomly divided into two groups (Group-A & Group-B). Group-A was treated with cyclophosphamide at a dose of 2.5 mg/kg/day for 60 days, along with tapering dose prednisolone for 8 weeks. The Group-B study population was treated with cyclosporine at a dose of 3 mg/kg/day for 6 months or longer along with tapering dose of alternate day prednisolone for the initial 8 weeks. Four patients in Group-B and one patient in Group-A did not continue the treatment. So, we followed-up 49 children during this period.
Results: The efficacy of both drugs was good after 6 months of treatment. Remission was observed in 80% of the cases in Group-A and 79% of the cases in Group-B. Even after 6 months of treatment 6.7% and 10.5% of the patients with SDNS in Group-A and Group-B needed to continue corticosteroid therapy, respectively. The side effects of immunosuppressive therapy were more frequently observed in Group-B patients. On the other hand, the mean serum creatinine level after 6 months therapy was 0.55±0.21mg/dl in Group-A and 0.84±0.43 mg/dl in Group-B. The difference between the two groups was statistically significant (p<0.05).
Conclusions: This study showed that both drugs were effective in FRNS and SDNS.
Keywords: Child; Nephrotic syndrome; Cyclophosphamide; Cyclosporine.- Childhood Nephrotic syndrome
- Cyclophosphamide
- Cyclosporine
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References
Hodson EM, Alexander SI, Graf N. Steroid-Sensitive Nephrotic Syndrome. In: Geary DF, Schaefer F (eds) Comprehensive Pediatric Nephrology, 1st edn. Mosby Elsevier, Philadelphia, 2008;239-256
Koskimies O, Vilska J, Rapola J, Hallman N. Long term outcome of primary nephrotic syndrome. Arch Dis Child 1982;57:544-548.
Tarshish P, Tobin JN, Bernstein J, Edelmann CM Jr. Prognostic significance of the early course of minimal change nephritic syndrome: report of the International Study of Kidney Disease in Children. J Am Soc Nephrol 1997;8:769-776.
Brodehl J. The treatment of minimal change nephrotic syndrome: lessons learned from multicentre co-operative studies [Review]. Eur J Pediatr 1991;150:380-387.
Latta K, von Schnakenburg C, Ehrich JH. A meta-analysis of cytotoxic treatment for frequently relapsing nephrotic syndrome in children. Pediatr Nephrol 2001;16:271-282.
Vester U, Kranz B, Zimmermann S, Hoyer PF Cyclophosphamide treatment in steroid-sensitive nephrotic syndrome: outcome and outlook. Pediatr Nephrol 2003;18:661-744.
Tejani A, Butt K, Trachtman H, Suthanthiran M, Rosenthal CJ, Khawar MR. Cyclosporine A induced remission of relapsing nephrotic syndrome in children. Kidney Int 1988;33: 729-734.
Durkan A, Hodson EM, Willis NS, Craig JC. Immunosuppressive agents in childhood nephrotic syndrome: a meta-analysis of randomized controlled trials. Kidney Int 2001;59:1919-27.
Durkan A, Hodson EM, Willis NS, Craig JC. Non-corticosteroid treatment for nephrotic syndrome in children. Update of Cochrane Database Syst Rev: CD002290,2005.
Hodson EM, Willis NS, Craig JC. Non-corticosteroid treatment for nephrotic syndrome in children (Review). The Cochrane Library Issue 4: CD002290,2010.
Ponticelli C, Edefonti A, Ghio L, Rizzoni G, Rinaldi S, R. Gusmano, G. Lama, G. Zacchello, R. Confalonieri, P. Altieri, A. Bettinelli, G. Maschio, G. A. Cinotti, G. Fuiano, F. P. Schena, A. Castellani, O. Delia Casa-Alberighi. Cyclosporine versus cyclophosphamide for patients with steroid dependent and frequently relapsing idiopathic nephrotic syndrome: a multicentre randomized controlled trial. Nephrol Dial Transplant 1993;8:1326-1332.
Niaudet P. Comparison of cyclosporine and chlorambucil in the treatment of steroid dependent idiopathic nephrotic syndrome: a multicentre randomized controlled trial. The French Society of Paediatric Nephrology, Peddiatr Nephrol 1992;6:1-3.
Podracka L, Boor A, Sasinka M. Cyclosporin A versus cyclophosphamide in the treatment of nephrotic syndrome in children. Cas Lek Cesk 2008;147:38-43
Habib R, Niaudet P. Comparison between pre- and posttreatment renal biopsies in children receiving cyclosporine for idiopathic nephrosis. Clin Nephrol 1994;42: 141-146.
Niaudet P, Broyer M, Habib R. Treatment of idiopathic nephrotic syndrome with cyclosporine A in children. Clin Nephrol 1991;35: 31-36.
Tirelli AS, Paterlini G, Ghio L, Edefonti A, Assael BM Bettinelli A, Cavanna G, Sereni F. Renal effects of cyclosporine A in children treated for idiopathic nephrotic syndrome. Acta Paediatr 1993;82:463-468.
Arbeitsgemeinschaft fiir Padiatrische Nephrologie. Cyclophosphamide treatment of steroid dependent nephrotic syndrome: comparison of eight-week with 12-week course. Arch Dis Child 1987;11:1102-1106.
Markus J. Kemper, Eberhard Kuwertz-Broeking, Monika Bulla, Dirk E. Mueller-Wiefe, Thomas J. Neuhaus. Recurrence of severe steroid dependency in cyclosporine A-treated childhood idiopathic nephrotic syndrome. Nephrol Dial Transplant 2004;19: 1136–1141.
Niaudet P, Habib R. Cyclosporine in the treatment of idiopathic nephrosis. J Am Soc Nephrol 1994;5: 1049–1056.
Hino S, Takemura T, Okada M. Follow-up study of children with nephrotic syndrome treated with a long-term moderate dose of cyclosporine. Am J of Kidney Disease 1998;31: 932–939.
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