Controlled trial of methylprednisolone pulses and low dose oral prednisone for the minimal change nephrotic syndrome.

Imbasciati, E; Gusmano, Rosanna; Edefonti, A.; Zucchelli, P; Pozzi, Claudio; Grassi, Claudio; Volpe, M Della; Perfumo, Francesco; Petrone, Patrizio; Picca, M.

doi:10.1136/bmj.291.6505.1305

Cited by 70 publications

(40 citation statements)

References 11 publications

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“…A small Italian randomized controlled trial of 67 pediatric and 22 adult MCD patients reported no efficacy of mPSL in accelerating remission and reducing relapse in 22 adult MCD patients (19). A Japanese retrospective cohort study reported a significantly higher incidence rate of relapse in patients treated with mPSL followed by PSL than in those patients who received PSL only (13).…”

Section: Discussionmentioning

confidence: 99%

“…An Italian randomized controlled trial showed that pediatric (not adult) MCD patients treated with mPSL and prednisone achieved remission earlier than those patients with prednisone alone (19). In another Japanese nonrandomized controlled trial of adult MCD patients, initial mPSL use followed by cyclosporine (not a Departments of *Geriatric Medicine and Nephrology, and corticosteroid) resulted in shorter time to remission compared with cyclosporine monotherapy and prednisolone (PSL) monotherapy (20).…”

Section: Introductionmentioning

confidence: 99%

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Comparison of Methylprednisolone Plus Prednisolone with Prednisolone Alone as Initial Treatment in Adult-Onset Minimal Change Disease

Shinzawa¹,

Yamamoto²,

Nagasawa³

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objectives 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.Design, setting, participants, & measurements This multicenter retrospective cohort study included 125 adultonset 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.Results 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,0.001). After achieving first remission, 32 (49.2%) patients in the methylprednisolone and prednisolone group and 43 (74.1%) patients in the prednisolone group developed at least one relapse. Multivariate Cox proportional hazards models revealed that methylprednisolone and prednisolone use was significantly associated with early remission (multivariate-adjusted hazard ratio, 1.56; 95% confidence interval, 1.06 to 2.30) and lower incidence of relapse (0.50; 95% confidence interval, 0.29 to 0.85) compared with prednisolone use alone. These results were ascertained in propensity score-based models. No significant difference was observed in incidence of adverse events, including infection, aseptic osteonecrosis, cataract, diabetes, and gastrointestinal bleeding.Conclusions Initial use of methylprednisolone was associated with earlier remission and lower incidence of relapse in adult-onset minimal change disease patients. Efficacy of methylprednisolone should be evaluated in randomized controlled trials.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison of Methylprednisolone Plus Prednisolone with Prednisolone Alone as Initial Treatment in Adult-Onset Minimal Change Disease

Shinzawa¹,

Yamamoto²,

Nagasawa³

et al. 2014

Clinical Journal of the American Society of Nephrology

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“…Imbasciati et al 34 performed a multicenter, randomized, prospective trial in 89 patients with MCD, 22 of whom were adults. The study group received intravenous methylprednisolone for 3 days (20 mg/kg per day) followed by low-dose prednisone for 6 months (starting dose of 0.5 mg/kg per day in adults for 4 weeks followed by taper over 5 months).…”

Section: Efficacymentioning

confidence: 99%

The Treatment of Minimal Change Disease in Adults

Hogan

Radhakrishnan

2013

Journal of the American Society of Nephrology

122

123

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Minimal change disease (MCD) is the etiology of 10%-25% of cases of nephrotic syndrome in adults. The mainstay of treatment for adult MCD, oral gucocorticoids, is based on two randomized controlled trials and extensive observational data in adults, and this treatment leads to remission in over 80% of cases. Relapses are common, and some patients become steroid-resistant (SR), steroid-dependent (SD), or frequently relapsing (FR). The data guiding the treatment of these patients are limited. Here, we review MCD in adults with particular focus on the evidence for immunosuppressive therapy in these patients.

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“…5). Furthermore, although Imbasciati et al (13) did not describe adult patients who had cosmetic problems in detail, there were fewer patients in the enhanced treatment group who developed obesity, facies, striae or other cosmetic problems.…”

Section: Adverse Events Of Treatmentmentioning

confidence: 98%

“…Six of the seven studies, involving 308 patients, published the effect of enhanced steroid therapy on the relapse rate in adult patients with MCNS (9)(10)(11)(12)(13)15). Patients were assigned to the enhanced treatment group (n=144) and the control group (n=164).…”

Section: Effect On Relapse Ratementioning

confidence: 99%

Enhanced Steroid Therapy in Adult Minimal Change Nephrotic Syndrome: A Systematic Review and Meta-analysis

et al. 2015

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The best regimen for adult minimal change nephrotic syndrome (MCNS) is still unknown. Due to an excessive number of adverse events caused by oral steroid monotherapy, enhanced steroid therapy (low dose of prednisolone with a short course of methylprednisolone or with another immunosuppressant) has been studied extensively for years. In this study, the PubMed, Embase, EBSCO and Cochrane Library databases were searched for clinical trials which compared enhanced steroid therapy with oral steroid monotherapy in adult MCNS and a meta-analysis was performed. Seven studies involving 357 patients were included. We found that patients treated with enhanced steroid therapy responded more quickly to complete remission (CR) [mean difference = -9.52, 95% confidence interval (CI): -12.66--6.39, p<0.00001] and showed fewer adverse events [risk radio (RR) = 0.72, 95% CI: 0.54-0.97, p=0.03] than patients receiving oral steroid monotherapy. The CR rate (RR= 0.96, 95% CI: 0.83-1.10, p=0.53) and relapse rate (RR=0.87, 95% CI: 0.57-1.34, p=0.53) were similar in both groups.

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Controlled trial of methylprednisolone pulses and low dose oral prednisone for the minimal change nephrotic syndrome.

Cited by 70 publications

References 11 publications

Comparison of Methylprednisolone Plus Prednisolone with Prednisolone Alone as Initial Treatment in Adult-Onset Minimal Change Disease

Comparison of Methylprednisolone Plus Prednisolone with Prednisolone Alone as Initial Treatment in Adult-Onset Minimal Change Disease

The Treatment of Minimal Change Disease in Adults

Enhanced Steroid Therapy in Adult Minimal Change Nephrotic Syndrome: A Systematic Review and Meta-analysis

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