Comparison of methylprednisolone plus prednisolone with prednisolone alone as initial treatment in adult-onset minimal change disease: a retrospective cohort study

• Published in: Clinical journal of the American Society of Nephrology 2014-06, Vol.9 (6), p.1040-1048
• Main Authors: Shinzawa, Maki, Yamamoto, Ryohei, Nagasawa, Yasuyuki, Oseto, Susumu, Mori, Daisuke, Tomida, Kodo, Hayashi, Terumasa, Izumi, Masaaki, Fukunaga, Megumu, Yamauchi, Atsushi, Tsubakihara, Yoshiharu, Isaka, Yoshitaka
• Format: Article
• Language: English
• Subjects: Adult; Anti-Inflammatory Agents - therapeutic use; Drug Therapy, Combination - adverse effects; Female; Humans; Male; Methylprednisolone - adverse effects; Methylprednisolone - therapeutic use; Middle Aged; Nephrosis, Lipoid - complications; Nephrosis, Lipoid - drug therapy; Original; Prednisolone - adverse effects; Prednisolone - therapeutic use; Proteinuria - etiology; Recurrence; Remission Induction - methods; Retrospective Studies; Time Factors; Young Adult
• ISSN: 1555-9041; 1555-905X
• DOI: 10.2215/CJN.12331213

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. 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. 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