Cyclophosphamide versus cyclosporine A therapy in steroid-resistant nephrotic syndrome: a retrospective study with a mean 5-year follow-up. Issue 11 (November 2018)

• Record Type: Journal Article
• Authors: Liu, Yanwei; Yang, Ruikun; Yang, Chen; Dong, Shuhong; Zhu, Ying; Zhao, Mingdong; Yuan, Fenglai; Gui, Keke
• Is Part Of: Journal of international medical research. Volume 46:Issue 11(2018)
• Page Start: 4506
• Page End: 4517
• Publication Date: 2018-11
• Subjects: Cyclophosphamide -- cyclosporine A -- steroid-resistant nephrotic syndrome -- relapse -- children -- minimal change disease; Medicine -- Periodicals; Pharmacology -- Periodicals; 610.5
• DOI: 10.1177/0300060518782017
• Languages: English
• ISSNs: 0300-0605

Abstract

Objective: To compare the clinical efficacy of cyclophosphamide (CTX) and cyclosporine A (CSA) in initial treatment of children with steroid-resistant nephrotic syndrome (SRNS). Methods: Prospectively maintained databases were reviewed to retrospectively compare two cohorts with SRNS that received peroral administration of 2 to 2.5 mg/kg/d CTX for 3 to 6 months or 1 to 5 mg/kg/d CSA for 2 years until the primary analysis cut-off date during 2007 to 2011. The time to first on-study relapse of SRNS was the primary endpoint. The effective rate was the second endpoint. Results: A total of 127 children with SRNS were included (CTX-treated cohort: n = 62; CSA-treated cohort: n = 65), with a mean 5-year follow-up. CTX-treated children showed a significantly delayed time to first on-study relapse of SRNS compared with CSA-treated children (hazard ratio 0.66, 95% confidence interval 0.32–1.75). The relapse rate (rate/year) in CTX-treated children (1.1 ± 0.1) at the 24-month follow-up was significantly higher than that with CSA (0.4 ± 0.2). This difference persisted until the final follow-up. Conclusions: CSA is associated with a significantly lower relapse rate and significantly higher effective rate compared with CTX, especially in children with minimal change disease.