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

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 t...

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Bibliographic Details
Published in:European journal of pediatrics 2013-04, Vol.172 (4), p.513-518
Main Authors: Fujinaga, Shuichiro, Someya, Tomonosuke, Watanabe, Tsuneki, Ito, Akira, Ohtomo, Yoshiyuki, Shimizu, Toshiaki, Kaneko, Kazunari
Format: Article
Language:English
Subjects:
Adolescent
Antibodies, Monoclonal, Murine-Derived - administration & dosage
Biopsy
Child
Cyclosporine - adverse effects
Cyclosporine - therapeutic use
Drug dosages
Female
Humans
Immunologic Factors - administration & dosage
Immunosuppressive Agents - adverse effects
Immunosuppressive Agents - therapeutic use
Kaplan-Meier Estimate
Kidney diseases
Maintenance Chemotherapy
Male
Medicine
Medicine & Public Health
Mycophenolic Acid - adverse effects
Mycophenolic Acid - analogs & derivatives
Mycophenolic Acid - therapeutic use
Nephrotic Syndrome - drug therapy
Original Article
Pediatrics
Prospective Studies
Rituximab
Secondary Prevention
Steroids
Steroids - adverse effects
Treatment Outcome
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Summary: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  
ISSN:0340-6199
1432-1076
DOI:10.1007/s00431-012-1913-3