Concomitant administration of cyclosporine and ketoconazole in idiopathic nephrotic syndrome.
BACKGROUND
The deliberate use of ketoconazole to reduce the need for cyclosporine (CsA) is not new, but it is particularly relevant because of the high cost of CsA. Many studies have documented this benefit in renal and cardiac transplants, but this co-administration has not been reported in patients with nephrotic syndrome.


METHODS
This retrospective study included 207 nephrotic patients who were steroid resistant, dependent or frequent relapsers and received CsA therapy. Among these patients 153 received daily ketoconazole therapy in a dose of 50 mg with concomitant decrease of one-third of the CsA dose while 54 patients received CsA alone. The majority of our cases were children (179 were below 18 years) and male to female ratio was 1.7:1.


RESULTS
The great majority of the study population received the drugs for 1-2 years. Patients who received CsA and ketoconazole were comparable with those who received CsA alone regarding age, sex, duration of renal disease, renal pathology, severity of nephrotic syndrome, renal function, hepatic function and steroid response. Co-administration of ketoconazole significantly reduced mean doses of CsA by 37% after 1 month and 47% at 1 year with overall net cost savings of 37%. Hepatic functions remained within the normal range in both groups. Additionally, co-administration of ketoconazole significantly improved the response to CsA therapy, successful steroid withdrawal and decreased the frequency of renal impairment.


CONCLUSIONS
Co-administration of keto with CsA in idiopathic nephrotic patients significantly reduces CsA costs and may improve its response.
El-Husseini
Amr
A
Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
El-Basuony
Fathy
F
Donia
Ahmed
A
Mahmoud
Ihab
I
Hassan
Nabil
N
Sayed-Ahmad
Nagy
N
Sobh
Mohamed
M
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use*; D002648:Child; D016572:Cyclosporine / Q000627:therapeutic use*; D004357:Drug Synergism; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007654:Ketoconazole / Q000627:therapeutic use*; D008297:Male; D009404:Nephrotic Syndrome / Q000188:drug therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D000935:Antifungal Agents; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D007654:Ketoconazole