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Evaluation of mycophenolate mofetil or tacrolimus in children with steroid sensitive but frequently relapsing or steroid‐dependent nephrotic syndrome
Author(s) -
Wang Jingjing,
Mao Jianhua,
Chen Junyi,
Fu Haidong,
Shen Huijun,
Zhu Xiujuan,
Liu Aimin,
Shu Qiang,
Du Lizhong
Publication year - 2016
Publication title -
nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 61
eISSN - 1440-1797
pISSN - 1320-5358
DOI - 10.1111/nep.12537
Subject(s) - medicine , nephrotic syndrome , tacrolimus , mycophenolate , gastroenterology , incidence (geometry) , adverse effect , cumulative incidence , minimal change disease , glomerulonephritis , focal segmental glomerulosclerosis , kidney , transplantation , physics , optics
Aim Approximately 30–40% of children with steroid sensitive nephrotic syndrome have frequently relapsing nephrotic syndrome ( FRNS ) or steroid‐dependent nephrotic syndrome ( SDNS ). Mycophenolate mofetil ( MMF ) and tacrolimus ( TAC ) are often alternative treatment choices for these patients. Methods A single‐center prospective study was conducted to compare the efficacy of MMF or TAC in reducing relapses and maintaining remission in children with FRNS or SDNS . Of the 72 recruited patients, either MMF (20∼30 mg/kg/d, n = 34) or TAC (0.05∼0.15 mg/kg/d, n = 38) was administered for 12 months. Results The mean 6‐month relapse rates decreased from 2.56 episodes before therapy to 0.76 episodes in the first 6 months after therapy (c 2 = 44.362, p < 0.001) and 0.67 in the next 6 months (c 2 = 37.817, p < 0.001) in the MMF group. In the TAC group, the mean 6‐month relapse rates decreased from 2.39 episodes before therapy to 0.41 episodes in the first 6 months after therapy (c 2 = 62.242, p < 0.001) and 0.42 in next 6 months (c 2 = 67.482, p < 0.001). No significant difference in the relapse rate was found between the groups (before therapy, c 2 = 0.902, p = 0.637; first 6 months, c 2 = 5.358, p = 0.147; second 6 months, c 2 = 4.089, p = 0.252). And there was also no significant difference in cumulative sustained remission and the incidence of adverse events between two groups. Conclusions In combination with low‐dose steroids, MMF or TAC presented similar efficacy in maintaining remission in children with FRNS / SDNS in the present study. Therapy with MMF or TAC is a promising strategy with a moderate risk of side effects in children who are steroid sensitive but have FRNS / SDNS .