title: Cyclosporine A vs. methylprednisolone for Henoch-Schönlein nephritis: a randomized trial.
abstract: Knowledge about how to treat severe Henoch-Schönlein nephritis (HSN) is scarce. The aim of our study is to compare cyclosporine A (CyA) and methylprednisolone pulses (MP) in the treatment of severe HSN. Out of 24 pediatric HSN patients with nephrotic-range proteinuria or crescentic HSN in kidney biopsy, seven were randomized to receive CyA for 12 months at an initial dose of 5 mg/kg and eight to receive 3 MP pulses of 30 mg/kg followed by prednisone for 4 months. The other nine patients received identical treatment without randomization. Kidney biopsies were performed at inclusion and after 2 years. The primary outcomes were the duration of proteinuria and hematuria, estimated glomerular filtration rate, and renal biopsy histology. All the 11 CyA-treated patients achieved resolution of nephrotic-range proteinuria within 3 months, while the MP-group response was slower, and in 6/13 was not achieved with the initial treatment. Additional immunosuppressive treatment was needed in none of the CyA-treated patients but in six patients treated with MP (difference in proportion 46%, p = 0.008). The 2-year control biopsies were similarly improved in both groups. After mean 6.1 years (2.2-10.4 years), 16 patients (eight CyA, eight MP) had no renal symptoms and six (three CyA, three MP) had persistent nephropathy but normal renal function. One MP-treated patient had reduced renal function and another had developed ESRD and received a renal transplant. CyA gave a 100% resolution of nephrotic-range proteinuria and a 100% renal survival rate without additional therapy after a mean follow-up of 6 years. Treatment of HSN with CyA is efficacious, safe and not inferior to MP.
authors.affiliation: Department of Children and Adolescents, Oulu University Hospital, PO Box 23, 90029, Oulu, Finland. ojauhola@paju.oulu.fi
authors.forename: Outi
authors.initials: O
authors.lastname: Jauhola
authors.forename: Jaana
authors.initials: J
authors.lastname: Ronkainen
authors.forename: Helena
authors.initials: H
authors.lastname: Autio-Harmainen
authors.forename: Olli
authors.initials: O
authors.lastname: Koskimies
authors.forename: Marja
authors.initials: M
authors.lastname: Ala-Houhala
authors.forename: Pekka
authors.initials: P
authors.lastname: Arikoski
authors.forename: Tuula
authors.initials: T
authors.lastname: Hölttä
authors.forename: Timo
authors.initials: T
authors.lastname: Jahnukainen
authors.forename: Jukka
authors.initials: J
authors.lastname: Rajantie
authors.forename: Timo
authors.initials: T
authors.lastname: Ormälä
authors.forename: Matti
authors.initials: M
authors.lastname: Nuutinen
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016572:Cyclosporine / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D011695:IgA Vasculitis / Q000150:complications / Q000188:drug therapy*; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use*; D009393:Nephritis / Q000188:drug therapy* / Q000209:etiology
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D008775:Methylprednisolone