Regional variations in immunosuppressive therapy in patients with primary nephrotic syndrome: the Japan nephrotic syndrome cohort study
Regional variations in immunosuppressive therapy in patients with primary nephrotic syndrome: the Japan nephrotic syndrome cohort study
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DOI：
10.1007/s10157-018-1579-x
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发表时间：
2018-12-01
影响因子：
2.3
通讯作者：
Isaka, Yoshitaka
中科院分区：
文献类型：
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作者：
Yamamoto, Ryohei;Imai, Enyu;Isaka, Yoshitaka
背景缺乏高质量的临床证据阻碍了对原发性肾病综合征最佳治疗方法的广泛共识。本研究的目的是比较日本6个地区的原发性肾病综合征患者的免疫抑制药物使用情况。方法2009至2010年间，56家医院的380名原发性肾病综合征患者进入前瞻性队列研究[日本肾病综合征队列研究(JNSCS)]，包括141名、151名和38名成人微小病变病(MCD)、膜性肾病(MN)和局灶节段性肾小球硬化(FSGS)患者。他们的临床特征与登记在全国范围内的肾活检登记处[日本肾活检登记处(J-RBR)]的患者进行了比较。在JNSCS接受免疫抑制治疗的成年MCD、MN和FSGS患者(n=139、127和34)中，评估了每种免疫抑制药物的区域使用情况。结果JNSCS患者的临床特征与J-RBR患者相似，提示JNSCS包含了J-RBR中的代表。其次为静脉注射甲基强的松龙[MCD 33例(24.6%)，MN 24例(19.7%)，FSGS 9例(28.1%)]和环孢素[25例(18.7%)，62例(50.8%)，16例(50.0%)]。该区域被认为是MCD和MN患者静脉注射甲基强的松龙的显著预测因素。结论在日本，静脉注射甲基强的松龙治疗MCD和MN的使用不同。它的疗效应该在精心设计的试验中进一步评估。
BackgroundThe lack of high-quality clinical evidences hindered broad consensus on optimal therapies for primary nephrotic syndromes. The aim of the present study was to compare prevalence of immunosuppressive drug use in patients with primary nephrotic syndrome across 6 regions in Japan.MethodsBetween 2009 and 2010, 380 patients with primary nephrotic syndrome in 56 hospitals were enrolled in a prospective cohort study [Japan Nephrotic Syndrome Cohort Study (JNSCS)], including 141, 151, and 38 adult patients with minimal change disease (MCD), membranous nephropathy (MN), and focal segmental glomerulosclerosis (FSGS), respectively. Their clinical characteristics were compared with those of patients registered in a large nationwide registry of kidney biopsies [Japan Renal Biopsy Registry (J-RBR)]. The regional prevalence of use of each immunosuppressive drug was assessed among adult MCD, MN, and FSGS patients who underwent immunosuppressive therapy in the JNSCS (n=139, 127, and 34, respectively). Predictors of its use were identified using multivariable-adjusted logistic regression models.ResultsThe clinical characteristics of JNSCS patients were comparable to those of J-RBR patients, suggesting that the JNSCS included the representatives in the J-RBR. The secondary major immunosuppressive drugs were intravenous methylprednisolone [n=33 (24.6%), 24 (19.7%), and 9 (28.1%) in MCD, MN, and FSGS, respectively] and cyclosporine [n=25 (18.7%), 62 (50.8%), and 16 (50.0%), respectively]. The region was identified as a significant predictor of use of intravenous methylprednisolone in MCD and MN patients.ConclusionUse of intravenous methylprednisolone for MCD and MN differed geographically in Japan. Its efficacy should be further evaluated in a well-designed trial.