Nephrotoxicity of once-daily cyclosporine A in minimal change nephrotic syndrome

Fujinaga, Shuichiro; Hirano, Daishi; Murakami, Hitohiko; Ohtomo, Yoshiyuki; Shimizu, Toshiaki; Kaneko, Kazunari

doi:10.1007/s00467-011-2076-6

Cited by 17 publications

(11 citation statements)

References 12 publications

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“…In the previous studies of mCyA treatment by C 2 monitoring for childhood FRNS, the mean relapse rates varied from 0.2 to 1.5 per year under the mean C 2 levels, which ranged from 497.8 to 729.0 ng/ml (13,16,18,20). The relapse rate in group A in the present study (0.41/person-year) was not inferior to the relapse rates in previous studies.…”

Section: Discussioncontrasting

confidence: 53%

“…One of the clinical benefits of C 2 monitoring, shown in the majority of studies on transplantation, is a reduction in mean cyclosporine dose, which may reduce the rate of adverse effects of cyclosporine, including chronic cyclosporine nephrotoxicity (12). Several reports described the efficacy and/or safety of mCyA treatment with C 2 monitoring, mainly with single daily dose, in children with FRNS (13)(14)(15)(16)(17)(18)(19)(20). However, there were few prospective studies to determine appropriate C 2 target with two divided oral doses of mCyA in children with FRNS.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Cyclosporine C2 Monitoring for the Treatment of Frequently Relapsing Nephrotic Syndrome in Children

Iijima¹,

Sako²,

Oba³

et al. 2014

Clinical Journal of the American Society of Nephrology

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to compare two protocols for treating children with frequently relapsing nephrotic syndrome using microemulsified cyclosporine.Design, setting, participants, & measurements Ninety-three children with frequently relapsing nephrotic syndrome were randomly assigned to group A (n=46) or group B (n=47). In both groups, the 2-hour postdose cyclosporine level was monitored. For group A, the cyclosporine target was set to 600-700 ng/ml for the first 6 months and 450-550 ng/ml for the next 18 months; for group B, it was set to 450-550 ng/ml for the first 6 months and 300-400 ng/ml for the next 18 months. The primary end point was the sustained remission rate. At the end of the study, if there was no difference in safety profile between the two groups and the sustained remission rate in group A was superior to group B with a decision threshold of 8%, then the regimen for group A would be determined the better treatment.Results Eight children from an ineligible institution, where cyclosporine levels were not measured, were excluded from all analyses. At 24 months, the sustained remission rate was nonsignificantly higher in group A (n=43) than group B (n=42; 64.4% versus 50.0%; hazard ratio, 0.57; 95% confidence interval, 0.29 to 1.11; P=0.09), and the progression-free survival rate was significantly higher (88.1% versus 68.4%; hazard ratio, 0.33; 95% confidence interval, 0.12 to 0.94; P=0.03). The relapse rate was significantly lower in group A than group B (0.41 versus 0.95 times/person-year; hazard ratio, 0.43; 95% confidence interval, 0.19 to 0.84; P=0.02). The rate and severity of adverse events were similar in both treatment groups. ConclusionThe sustained remission rate was not significantly different between the two treatment groups, but the regimen with the higher 2-hour postdose cyclosporine level target improved progression-free survival and reduced the relapse rate.

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Section: Discussioncontrasting

confidence: 53%

Section: Introductionmentioning

confidence: 99%

Cyclosporine C2 Monitoring for the Treatment of Frequently Relapsing Nephrotic Syndrome in Children

Iijima¹,

Sako²,

Oba³

et al. 2014

Clinical Journal of the American Society of Nephrology

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“…Once-daily dosing with lowered trough levels may be associated with reduced nephrotoxicity and increased drug adherence (compliance). However, a report described that the incidence of nephrotoxicity with oncedaily dosing did not differ compared with twice-daily dosing [46], and further studies are required to clarify the efficacy and safety of once-daily administration of cyclosporine.…”

Section: Cyclosporinementioning

confidence: 91%

Clinical practice guideline for pediatric idiopathic nephrotic syndrome 2013: medical therapy

et al. 2015

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“…Nevertheless, some patients will relapse and steroid dependence may be replaced by calcineurin inhibitor dependence requiring years of treatment and the associated risk of nephrotoxicity (4). Although the risk of nephrotoxicity can be minimized by lowering the maintenance dose of cyclosporine (47), it still can occur even with the use of low cyclosporine doses (54,55).…”

Section: Discussion Of Casementioning

confidence: 99%

American Society of Nephrology Quiz and Questionnaire 2013

Fervenza

Perazella

Choi

2014

Clinical Journal of the American Society of Nephrology

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The Nephrology Quiz and Questionnaire (NQ&Q) remains an extremely popular session for attendees of the Annual Meeting of the American Society of Nephrology. As in past years, the conference hall of the 2013 meeting was overflowing with interested audience members. Topics covered by expert discussants included electrolyte and acid-base disorders, glomerular disease, ESRD/dialysis, and transplantation. Complex cases representing each of these categories, along with single best answer questions, were prepared by a panel of experts. Before the meeting, program directors of United States nephrology training programs answered questions through an Internet-based questionnaire. A new addition to the NQ&Q was participation in the questionnaire by nephrology fellows. To review the process, members of the audience test their knowledge and judgment on a series of caseoriented questions prepared and discussed by experts. Their answers are compared in real time using audience response devices with the answers of nephrology fellows and training program directors. The correct and incorrect answers are then briefly discussed after the audience responses and the results of the questionnaire are displayed. This article recapitulates the session and reproduces its educational value for CJASN readers. Enjoy the clinical cases and expert discussions.

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Nephrotoxicity of once-daily cyclosporine A in minimal change nephrotic syndrome

Cited by 17 publications

References 12 publications

Cyclosporine C2 Monitoring for the Treatment of Frequently Relapsing Nephrotic Syndrome in Children

Cyclosporine C2 Monitoring for the Treatment of Frequently Relapsing Nephrotic Syndrome in Children

Clinical practice guideline for pediatric idiopathic nephrotic syndrome 2013: medical therapy

American Society of Nephrology Quiz and Questionnaire 2013

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