Efficacy of intravenous pulse cyclophosphamide treatment versus combination of intravenous dexamethasone and oral cyclophosphamide treatment in steroid-resistant nephrotic syndrome

Abstract

We compared, in a randomized controlled trial, the efficacy of a regimen based on intravenous (i.v.) cyclophosphamide therapy with a combination of i.v. dexamethasone and oral cyclophosphamide therapy in inducing remission in patients with steroid-resistant nephrotic syndrome (SRNS). During April 2001 to December 2003, 52 consecutive patients with idiopathic SRNS, normal renal function and renal histology findings showing minimal change disease, focal segmental glomerulosclerosis or mesangioproliferative glomerulonephritis were enrolled into the study. Patients in group I received i.v. injection of cyclophosphamide once a month for 6 months and prednisolone on alternate days. Those in group II received i.v. treatment with dexamethasone (initially on alternate days, later fortnightly and monthly; total 14 doses), oral cyclophosphamide therapy (for 3 months) and prednisolone on alternate days. Data from 49 patients (26 in group I, 23 in group II) were analyzed; their clinical and biochemical features were similar at inclusion. Following treatment, complete remission was seen in 53.8% and 47.8% patients in groups I and II, respectively (P = 0.6). Long-term follow up showed favorable outcome in 14 (53.8%) patients in group I, and 9 (39.1%) in group II. Chief adverse effects, including cushingoid features and serious infections, were similar in both groups. Patients receiving i.v. dexamethasone therapy commonly showed hypertension and hypokalemia, while vomiting and reversible alopecia occurred in those receiving i.v. treatment with cyclophosphamide. In patients with SRNS, the efficacy of treatment intravenously with cyclophosphamide and orally with prednisolone was similar to the combination of dexamethasone intravenously, orally administered cyclophosphamide and prednisolone.

Long-term outcome of idiopathic steroid-resistant nephrotic syndrome in children

“…3). Treatment regimens for patients with SRNS that include oral cyclophosphamide have been tentatively advocated by the authors of a number of reports (including patients with FSGS) [16,21]; however, the results of our study suggest that the treatment regimen of oral cyclophosphamide can not be recommended-at least not to patients with SRNS with the FSGS histopathological pattern. Our institution has not adopted regimens with intravenous cyclophosphamide for the treatment of children with SRNS, but the results of other studies evaluating the efficacy of such therapeutic regimens are conflicting [12,22,23].…”

Long-term outcome of idiopathic steroid-resistant nephrotic syndrome: a multicenter study

“…New trials of other immunosuppressive regimens in the treatment of SRNS have been reported [25][26][27][28][29]. Tacrolimus was an effective and well-tolerated option for SRNS patients suffering therapy resistance, dependence or intolerable side effects from other drugs [25][26][27].…”

Steroid resistant nephrotic syndrome in children: Clinical presentation, renal histology, complications, treatment and outcome at Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh

“…Children; data modified to conform to this tabulationMean age of presentation was 9.2 year which meant SRNS is common in higher age group. The mean age at onset of the SRNS in this and other studies Appeared to be a function of the glomerular morphologic lesion as children with MCD-associated SRNS tend to be younger (2.2-5.1 years)4 12,23,24,25 than those with non-MCD-associated SRNS who are older (6.2-8.72 years) [26][27][28][29] . Hypertension and hematuria are common features of non-MCD.…”

“…With the above mentioned treatment 21 (65.63%) achieved response which was similar to many other studies as different author found different levels of remission ranging from 14.8-80% depending upon various protocol 11 . Mantan et al 23 and Harri et al 32 respectively achieved 47.8% and 35.1% remission rate using i.v. dexamethasone and oral cyclophosphamide and prednisolone.…”