Tacrolimus improves proteinuria remission in adults with cyclosporine A‐resistant or ‐dependent minimal change disease. Issue 3 (March 2017) - Xu, Dechao
Abstract: Aims: Cyclosporin A (CsA) is considered as an effective treatment option for steroid‐resistant or‐dependent patients with adult‐onset minimal change disease (MCD). However, CsA resistance or dependence is also observed in these patients. Tacrolimus (TAC) is a calcineurin inhibitor that is potent in cytokine suppression. The authors aim to evaluate the efficacy and safety of TAC therapy in CsA‐resistant and‐dependent adult‐onset MCD patients. Methods: Patients with adult‐onset MCD were enrolled in our department from 2008 to 2012. All patients were demonstrated to be resistant to or dependent on CsA therapy. Prednisone (0.5 mg/kg per day) combined with TAC (0.05–0.1 mg/kg per day) were prescribed to these patients for at least 6 months. The primary outcome was complete or partial remission of proteinuria. Secondary outcomes included time required for complete or partial remission, adverse events, number of relapses, and TAC dosages. Results: A total of 11 MCD patients were enrolled in this observational study. The numbers of patients who presented with resistance to or dependence on CsA were 7 and 4, respectively. The total remission rate was 90.9% (10/11) with the complete remission rate 72.7% (8/11). Most remission patients achieved remission during the first 2 months of TAC therapy. Patients who presented with dependence on CsA had achieved complete remission with TAC therapy, while outcomes for CsA‐resistant patients were four complete remissions, two partial remissions and one resistance. The adverse events were observed in this study included infection, diarrhoea, and worsened hypertension. Five patients who had remission experienced relapse. Conclusions: Tacrolimus improves proteinuria remission in adults with CsA‐resistant or ‐dependent MCD. Summary at a Glance: This is an observational study of Tacrolimus effects on CsA‐resistant and‐dependent adult‐onset MCD patients. The authors found that Tacrolimus could improve proteinuria remission in these patients. A total of 11 these patients were enrolled in this study, The total remission rate was 90.9% (10/11) with the complete remission rate 72.7% (8/11). Hence, Tacrolimus may be used as an effective treatment option for these kinds of patients.