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

Fujinaga, Shuichiro; Someya, Tomonosuke; Watanabe, Tsuyoshi; Itō, Akira; Ohtomo, Yoshiyuki; Shimizu, Toshiaki; Kaneko, Kazunari

doi:10.1007/s00431-012-1913-3

Cited by 39 publications

(23 citation statements)

References 20 publications

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“…A therapeutic window for MPA AUC 12 in autoimmune disease patients has not been established yet and it is not clear whether or how MPA C trough in people with autoimmune disease relate to MPA exposure (Abd Rahman et al, 2014). To our knowledge, for children with nephrotic syndrome there are still not many studies concerning target MPA pharmacokinetic parameters, associated with obtaining a remission of the disease (Fujinaga et al, 2013;Gellermann et al, 2013). Therefore, in children included in the study, we focused mainly on MPA C trough and AUC 12 values and their relation to the efficacy of MMF treatment.…”

Section: Discussionmentioning

confidence: 95%

Monitoring of mycophenolate mofetil metabolites in children with nephrotic syndrome and the proposed novel target values of pharmacokinetic parameters

Sobiak

Resztak

Ostalska‐Nowicka

et al. 2015

European Journal of Pharmaceutical Sciences

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Section: Discussionmentioning

confidence: 95%

Monitoring of mycophenolate mofetil metabolites in children with nephrotic syndrome and the proposed novel target values of pharmacokinetic parameters

Sobiak

Resztak

Ostalska‐Nowicka

et al. 2015

European Journal of Pharmaceutical Sciences

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“…A Japanese group [ 18 ] reported that maintenance therapy with MMF can help avoid the repeated use of RTX and may contribute to its safer use, as well as to fewer serious RTX-associated adverse events. In contrast, another Japanese group [ 19 ] compared cyclosporine with MMF for maintenance of SDNS remission after a single infusion of RTX and found that cyclosporine appeared to be more effective than MMF. In our study, CNI was used only in cases of relapse, and no patients received MMF at the time of initial RTX treatment or thereafter.…”

Section: Discussionmentioning

confidence: 99%

Long-term repeated rituximab treatment for childhood steroid-dependent nephrotic syndrome

Kim

Park

Hyun

et al. 2017

Kidney Res Clin Pract.

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BackgroundRituximab (RTX) can be used as a rescue therapy for steroid-dependent nephrotic syndrome (SDNS). However, the efficacy and safety of long-term, repeated use of RTX are not established. This study was conducted to assess the efficacy and safety of long-term, repeated RTX treatment in children.MethodsEighteen consecutive child patients with SDNS who were treated with three or more cycles of RTX for one year or longer were recruited, and their medical records were retrospectively reviewed.ResultsThe patients were followed for 4.7 ± 1.9 years and received 5.2 ± 2.3 cycles of RTX over 2.8 ± 1.1 years. Approximately 70% of the additional RTX cycles were administered due to recovery of B-cells without relapse. The relapse rate decreased from 3.4 ± 2.0 per year initially to 0.4 ± 0.8 per year at the third year after RTX treatment. Approximately 10% of the RTX infusions were accompanied by mild infusion reactions. Eight patients showed sustained remission without any oral medication after the last cycle of RTX, while 10 patients had one or more episodes of relapse after the last cycle of RTX. The relapse rate in the latter group decreased from 2.8 ± 1.5 per year before RTX treatment to 1.3 ± 0.8 per year after cessation of RTX treatment. No significant differences in clinical parameters were found between the two groups.ConclusionThis retrospective study showed that pre-emptive and long-term, repeated RTX treatment is relatively effective and safe in children with SDNS. However, well-designed prospective studies are needed to confirm these findings.

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“…Low-quality evidence supports the use of alkylating agents such as cyclophosphamide in SDNS and FRNS podocytopathies to reduce the cumulative dose of steroids 146 but these regimens have been progressively abandoned in developed countries owing to their unfavourable safety profile (TABlE 2). In paediatric patients, mycophenolate mofetil seems equally as effective as levamisole 189 but not as effective as ciclosporin in achieving remission [190][191][192] , although the evidence is still limited 157 . In addition, higher doses of mycophenolate mofetil than those used in kidney-transplanted recipients seem to be necessary in children with nephrotic syndrome to achieve remission 192 .…”

Section: Sdns and Frnsmentioning

confidence: 99%

Podocytopathies

Kopp

Anders

Suszták

et al. 2020

Nat Rev Dis Primers

307

270

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Podocytopathies are kidney diseases in which direct or indirect podocyte injury drives proteinuria or nephrotic syndrome. In children and young adults, genetic variants in >50 podocyte-expressed genes, syndromal non-podocyte-specific genes and phenocopies with other underlying genetic abnormalities cause podocytopathies associated with steroid-resistant nephrotic syndrome or severe proteinuria. A variety of genetic variants likely contribute to disease development. Among genes with non-Mendelian inheritance, variants in APOL1 have the largest effect size. In addition to genetic variants, environmental triggers such as immune-related, infection-related, toxic and haemodynamic factors and obesity are also important causes of podocyte injury and frequently combine to cause various degrees of proteinuria in children and adults. Typical manifestations on kidney biopsy are minimal change lesions and focal segmental glomerulosclerosis lesions. Standard treatment for primary podocytopathies manifesting with focal segmental glomerulosclerosis lesions includes glucocorticoids and other immunosuppressive drugs; individuals not responding with a resolution of proteinuria have a poor renal prognosis. Renin-angiotensin system antagonists help to control proteinuria and slow the progression of fibrosis. Symptomatic management may include the use of diuretics, statins, infection prophylaxis and anticoagulation. This Primer discusses a shift in paradigm from patient stratification based on kidney biopsy findings towards personalized management based on clinical, morphological and genetic data as well as pathophysiological understanding.

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

Abstract: In patients with severe steroid-dependent NS, CsA appears to be more effective than MMF for maintaining remission after a single infusion of RTX.

Cited by 39 publications

References 20 publications

Monitoring of mycophenolate mofetil metabolites in children with nephrotic syndrome and the proposed novel target values of pharmacokinetic parameters

Monitoring of mycophenolate mofetil metabolites in children with nephrotic syndrome and the proposed novel target values of pharmacokinetic parameters

Long-term repeated rituximab treatment for childhood steroid-dependent nephrotic syndrome

Podocytopathies

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