Comparison of methylprednisolone plus prednisolone with prednisolone alone as initial treatment in adult-onset minimal change disease: a retrospective cohort study.
OBJECTIVE
Previous studies suggested that intravenous methylprednisolone possibly accelerates remission of proteinuria in adult-onset minimal change disease; its impact on relapse of proteinuria is unknown.


METHODS
This multicenter retrospective cohort study included 125 adult-onset minimal change disease patients diagnosed by kidney biopsy between 2000 and 2009 and treated initially with corticosteroid in five nephrology centers in Japan participating in the Study of Outcomes and Practice Patterns of Minimal Change Disease. Times to first remission and first relapse of proteinuria after initiating the first immunosuppressive therapy were compared between 65 patients with initial use of intravenous methylprednisolone followed by prednisolone and 60 patients with initial use of prednisolone alone using multivariate Cox proportional hazards models. After calculating the probability of receiving methylprednisolone and prednisolone using a logistic regression model (propensity score), the results were ascertained using propensity score-matched and -stratified models.


RESULTS
During the median 3.6 years of observation (interquartile range=2.0-6.9), all 65 patients in the methylprednisolone and prednisolone group achieved remission within 11 (8-20) days of the corticosteroid initiation, whereas in the prednisolone group, 58 of 60 patients (96.7%) achieved remission within 19 (12-37) days (P<0.001). After achieving first remission, 32 (49.2%) patients in the methylprednisolone and prednisolone group and 43 (74.1%) patients in the prednisolone group developed at least one relapse. Multivariate Cox proportional hazards models revealed that methylprednisolone and prednisolone use was significantly associated with early remission (multivariate-adjusted hazard ratio, 1.56; 95% confidence interval, 1.06 to 2.30) and lower incidence of relapse (0.50; 95% confidence interval, 0.29 to 0.85) compared with prednisolone use alone. These results were ascertained in propensity score-based models. No significant difference was observed in incidence of adverse events, including infection, aseptic osteonecrosis, cataract, diabetes, and gastrointestinal bleeding.


CONCLUSIONS
Initial use of methylprednisolone was associated with earlier remission and lower incidence of relapse in adult-onset minimal change disease patients. Efficacy of methylprednisolone should be evaluated in randomized controlled trials.
Departments of Geriatric Medicine and Nephrology, and.
Maki
M
Shinzawa
Departments of Geriatric Medicine and Nephrology, and.
Ryohei
R
Yamamoto
Departments of Geriatric Medicine and Nephrology, and.
Yasuyuki
Y
Nagasawa
Division of Nephrology, Department of Internal Medicine, Toyonaka Municipal Hospital, Toyonaka, Japan;
Susumu
S
Oseto
Division of Nephrology, Department of Internal Medicine, Osaka Rosai Hospital, Sakai, Osaka, Japan;
Daisuke
D
Mori
Department of Internal Medicine, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan; and.
Kodo
K
Tomida
Department of Kidney Disease and Hypertension, Osaka General Medical Center, Osaka, Japan.
Terumasa
T
Hayashi
Department of Internal Medicine, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan; and.
Masaaki
M
Izumi
Division of Nephrology, Department of Internal Medicine, Toyonaka Municipal Hospital, Toyonaka, Japan;
Megumu
M
Fukunaga
Division of Nephrology, Department of Internal Medicine, Osaka Rosai Hospital, Sakai, Osaka, Japan;
Atsushi
A
Yamauchi
Department of Kidney Disease and Hypertension, Osaka General Medical Center, Osaka, Japan Comprehensive Kidney Disease Research, Osaka University Graduate School of Medicine, Suita, Osaka, Japan;
Yoshiharu
Y
Tsubakihara
Departments of Geriatric Medicine and Nephrology, and isaka@kid.med.osaka-u.ac.jp.
Yoshitaka
Y
Isaka
D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D004359:Drug Therapy, Combination / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008775:Methylprednisolone / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D009402:Nephrosis, Lipoid / Q000150:complications / Q000188:drug therapy*; D011239:Prednisolone / Q000009:adverse effects / Q000627:therapeutic use*; D011507:Proteinuria / Q000209:etiology; D012008:Recurrence; D012074:Remission Induction / Q000379:methods; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult
D000893:Anti-Inflammatory Agents; D011239:Prednisolone; D008775:Methylprednisolone
GN; drug interactions; nephrotic syndrome