Cyclosporine versus mycophenolate mofetil for maintenance of remission of steroid-dependent nephrotic syndrome after a single infusion of rituximab.

Abstract

UNLABELLED:

The efficacy of rituximab (RTX) as the sole therapy for preventing relapses of nephrotic syndrome (NS) is transient in most patients; therefore, the optimal therapy required for maintaining a successful response to a biological agent remains a challenge. We conducted a prospective study to compare the efficacy of cyclosporine (CsA) with that of mycophenolate mofetil (MMF) as maintenance therapy after a single infusion of RTX. Of 29 patients with persistent steroid-dependent NS despite the use of CsA and/or MMF, 13 without chronic nephrotoxicity continued CsA therapy, maintaining a 2-h post-dose CsA level of 400-500 ng/ml (CsA group). The remaining 16 were treated with MMF, maintaining a pre-dose level of 2-5 μg/ml of mycophenolic acid (MMF group). The median duration of CsA and MMF treatment was 18 and 19 months, respectively. Despite the mean number of relapses before RTX treatment being significantly lower in the MMF group than in the CsA group (2.3/year vs. 4.6/year, p < 0.01), treatment failure occurred more frequently in the MMF group (7/16) than in the CsA group (2/13). The rate of sustained remission was also significantly higher in the CsA group than in the MMF group (p < 0.05).

CONCLUSION:

In patients with severe steroid-dependent NS, CsA appears to be more effective than MMF for maintaining remission after a single infusion of RTX.

• Authors: Shuichiro Fujinaga, Tomonosuke Someya, Tsuneki Watanabe, Akira Ito, Yoshiyuki Ohtomo, Toshiaki Shimizu, Kazunari Kaneko
• Journal: European journal of pediatrics (Eur J Pediatr) Vol. 172 Issue 4 Pg. 513-8 (Apr 2013) ISSN: 1432-1076 [Electronic] Germany
• PMID: 23271494 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Antibodies, Monoclonal, Murine-Derived
• Immunologic Factors
• Immunosuppressive Agents
• Steroids
• Rituximab
• Cyclosporine
• Mycophenolic Acid

Topics

• Adolescent
• Antibodies, Monoclonal, Murine-Derived (administration & dosage)
• Child
• Cyclosporine (adverse effects, therapeutic use)
• Female
• Humans
• Immunologic Factors (administration & dosage)
• Immunosuppressive Agents (adverse effects, therapeutic use)
• Kaplan-Meier Estimate
• Maintenance Chemotherapy
• Male
• Mycophenolic Acid (adverse effects, analogs & derivatives, therapeutic use)
• Nephrotic Syndrome (drug therapy)
• Prospective Studies
• Rituximab
• Secondary Prevention
• Steroids (adverse effects)
• Treatment Outcome