Significance of combined cyclosporine-prednisolone therapy and cyclosporine blood concentration monitoring for idiopathic membranous nephropathy with steroid-resistant nephrotic syndrome: a randomized controlled multicenter trial

Clinical and Experimental Nephrology
Takao SaitoRefractory Nephrotic Syndrome Study Group

Abstract

Combined treatment with cyclosporine microemulsion preconcentrate (CyA MEPC) and steroids has been widely used for idiopathic membranous nephropathy (IMN) associated with steroid-resistant nephrotic syndrome (SRNS). Recent studies have shown that once-a-day and preprandial administration of CyA MEPC is more advantageous than the conventional twice-a-day administration in achieving the target blood CyA concentration at 2 h post dose (C2). We designed a randomized trial to compare these administrations. IMN patients with SRNS (age 16-75 years) were divided prospectively and randomly into 2 groups. In group 1 (n = 23), 2-3 mg/kg body weight (BW) CyA MEPC was given orally once a day before breakfast. In group 2 (n = 25), 1.5 mg/kg BW CyA MEPC was given twice a day before meals. CyA + prednisolone was continued for 48 weeks. Group 1 showed a significantly higher cumulative complete remission (CR) rate (p = 0.0282), but not when incomplete remission 1 (ICR1; urine protein 0.3-1.0 g/day) was added (p = 0.314). Because a C2 of 600 ng/mL was determined as the best cut-off point, groups 1 and 2 were further divided into subgroups A (C2 ≥600 ng/mL) and B (C2 <600 ng/mL). Groups 1A and 2A revealed significantly higher cumulative remission ...Continue Reading

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Citations

Oct 27, 2016·Clinical and Experimental Nephrology·Takao SaitoUNKNOWN Refractory Nephrotic Syndrome Study Group
Oct 17, 2014·The Cochrane Database of Systematic Reviews·Yizhi ChenAnnalisa Perna
Nov 2, 2016·The Cochrane Database of Systematic Reviews·Elisabeth M HodsonJonathan C Craig
Jul 27, 2017·Terapevticheskiĭ arkhiv·V A DobronravovA V Smirnov
Nov 22, 2019·The Cochrane Database of Systematic Reviews·Isaac D LiuElisabeth M Hodson
Nov 16, 2021·The Cochrane Database of Systematic Reviews·Thilo C von GrooteDavid J Tunnicliffe

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