The efficacy of cyclosporine A in adult nephrotic syndrome with minimal change disease and focal-segmental glomerulosclerosis: a multicenter study in Korea.
A multicenter prospective study conducted in four university hospitals in Korea investigated the efficacy and tolerance of cyclosporine A (CyA, Sandimmun) in 30 patients with adult nephrotic syndrome [25 patients with minimal change disease (MCD) and 5 with focal-segmental glomerulosclerosis (FSGS)]. After a 6-week washout period, CyA 5 mg/kg/day and prednisolone 10 mg/day were administered for up to 8 months, depending on responses to CyA. The rate of relapse after withdrawal of CyA was assessed up to 10 months. Of the 30 patients enrolled, 3 withdrew prematurely due to adverse events. Of the 27 patients who completed the study, 22 had MCD and 5 had FSGS. The prior steroid responses of these patients were 19 steroid-dependent (SD), 4 frequent-relapser (FR) and 4 steroid-resistant (SR) type. High rates of complete remission were obtained after CyA treatment in both MCD and FSGS patients, 86.4% (19/22) and 80% (4/5) respectively. Previous steroid responses did not affect the response to CyA; complete remission was obtained in 84.2% (16/19) of SD patients and in 75% (3/4) of SR patients. The mean (+/- SEM) duration of CyA treatment to attain complete remission in SD and SR patients was 3.8 (+/- 0.6) weeks and 10.7 (+/- 2.7) weeks, respectively (not significantly different). Tapering or withdrawal of CyA was followed by release of nephrotic syndrome in many patients, and the cumulative relapse rates at month 10 were 68.4% (13/19) in MCD patients and 50% (2/4) in FSGS patients. When considered according to prior steroid responses, the relapse rate was 73.3% (11/15) in SD patients and 50% (2/4) in SR patients.(ABSTRACT TRUNCATED AT 250 WORDS)
Lee
H Y
HY
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Kim
H S
HS
Kang
C M
CM
Kim
S G
SG
Kim
M J
MJ
D000293:Adolescent; D000328:Adult; D016572:Cyclosporine / Q000009:adverse effects / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D005923:Glomerulosclerosis, Focal Segmental / Q000188:drug therapy*; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007723:Korea; D008297:Male; D008875:Middle Aged; D009402:Nephrosis, Lipoid / Q000188:drug therapy*; D009404:Nephrotic Syndrome / Q000188:drug therapy*; D011239:Prednisolone / Q000627:therapeutic use; D011446:Prospective Studies; D012008:Recurrence; D016896:Treatment Outcome
D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D011239:Prednisolone