2010
DOI: 10.1007/s00467-010-1707-7
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Single daily high-dose mizoribine therapy for children with steroid-dependent nephrotic syndrome prior to cyclosporine administration

Abstract: Although cyclosporine (CsA) therapy is effective in the management of children with steroid-dependent nephrotic syndrome (SDNS), a recent study has revealed that the use of CsA itself was a significant predictor of NS relapse in adulthood. The efficacy of single daily high-dose mizoribine (MZR) therapy was assessed in 10 children with SDNS (mean age, 6.2 years) who had never been treated with CsA previously. MZR was started at 5 mg/kg, administered as a single daily dose after breakfast, and the dose was adjus… Show more

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Cited by 24 publications
(8 citation statements)
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References 16 publications
(28 reference statements)
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“…Its efficacy in preventing relapse is not as potent as CPA or cyclosporine (CsA). However, high-dose MZR is broadly used for SDNS and FRNS in Japan because of its safety for long-term use, which is similar to that reported for MMF in the USA [7,8]. In our study, we treated nine patients with SDNS with 4.4-9.4 mg/kg of MZR, once-daily dosing, beginning on the day following discontinuation of CPA, and observed the patients for 2 years.…”
supporting
confidence: 55%
“…Its efficacy in preventing relapse is not as potent as CPA or cyclosporine (CsA). However, high-dose MZR is broadly used for SDNS and FRNS in Japan because of its safety for long-term use, which is similar to that reported for MMF in the USA [7,8]. In our study, we treated nine patients with SDNS with 4.4-9.4 mg/kg of MZR, once-daily dosing, beginning on the day following discontinuation of CPA, and observed the patients for 2 years.…”
supporting
confidence: 55%
“…In our trial and that of Bagga et al [14], SDNS children received MMF after one course of cyclophosphamide had failed to improve steroid dependency, as commonly done in recent decades. Interestingly, mizoribine, a purine-metabolism inhibitor that mimics MMF, has been shown to induce a significant reduction of prednisolone dose and relapse rate in nine of ten children with SDNS who had received neither cyclophosphamide nor cyclosporine previously [42]. Therefore, cyclophosphamide, because of its adverse effects and relatively low efficacy in SDNS [34][35][36], should now rather be positioned after MMF and cyclosporine, as proposed [38,39].…”
Section: Discussionmentioning
confidence: 88%
“…Multiple studies of high-dose mizoribine therapy for frequently-relapsing and steroid-dependent nephrotic syndrome were then reported, including those investigating the efficacy and safety of mizoribine at 10 mg/kg/day (maximum 500 mg) twice a week [71], 6 mg/kg/day (maximum 300 mg) twice a week [72], a mean of 14.3 mg/kg/day twice a week [73], a mean of 10.1 mg/kg/day daily [74], and a mean of 8.4 mg/kg/day daily [75]. A cohort study comparing the standard dose (4-6 mg/kg/day) and highdose (7-10 mg/kg/day) of mizoribine demonstrated superior efficacy of high-dose therapy, with a significant decrease in the number of relapses in patients with a peak blood mizoribine concentration of 3.0 lg/mL or higher [76].…”
Section: Mizoribinementioning
confidence: 99%