Induction and long-term treatment with cyclosporine in membranous nephropathy with the nephrotic syndrome
Induction and long-term treatment with cyclosporine in membranous nephropathy with the nephrotic syndrome
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DOI：
10.1093/ndt/gfl360
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发表时间：
2006-11-01
影响因子：
6.1
通讯作者：
Memmos, Dimitrios
中科院分区：
文献类型：
--
作者：
Alexopoulos, Efstathios;Papagianni, Aikaterini;Memmos, Dimitrios
背景环孢菌素A（CyA）已被证明是有效的膜性肾病（MN）。然而，最佳剂量和治疗持续时间仍然是有争议的问题。我们评估了小剂量CyA单独或联合皮质类固醇作为MN肾病患者的诱导和长期治疗的疗效。在研究的第一部分中，51例MN肾病患者接受CyA和泼尼松龙（n = 31）或CyA单独（n = 20）治疗12个月。完全缓解（CR）或部分缓解（PR）的患者接受低剂量CyA和泼尼松龙或单用CyA的长期治疗。研究第二部分的平均随访时间分别为26 +/- 16个月和18 +/- 7个月。治疗12个月后，联合组26例患者和单药组17例患者的蛋白尿达到CR或PR（P = NS）。两组肾功能无变化。在长期治疗中，单药治疗组复发率更高（47% vs 15%，P < 0.05）。在两组中，非复发者的每日CyA剂量更高（组合1.4 +/- 0.5 vs 1.0 +/- 0.3 mg/kg，P < 0.001，单药治疗1.5 +/- 0.4 vs 1.1 +/- 0.2 mg/kg，P < 0.003）。两组复发者的CyA谷浓度（72 +/- 48 ng/ml）均低于非复发者（194 +/- 80 ng/ml）（P < 0.03）。随访期间肾功能和蛋白尿保持稳定。这项研究表明，12个月的治疗与CyA（+/-泼尼松龙）是有效的诱导缓解大多数肾病患者MN和肾功能保存良好。较长时间的低剂量治疗是维持缓解的有效方法。复发在单药治疗组中更频繁发生，通常与CyA谷水平< 100 ng/ml相关。
Background. Cyclosporine A (CyA) has been shown to be effective in membranous nephropathy (MN). However, the optimal dose and the duration of treatment remain controversial issues. We evaluated the efficacy of low-dose CyA alone or combined with corticosteroids as induction and long-term treatment for nephrotic patients with MN.Methods. In the first part of the study, 51 nephrotic patients with MN were treated either with CyA and prednisolone (n = 31) or CyA alone (n = 20) for 12 months. Patients who responded with complete remission (CR) or partial remission (PR) were placed on long-term treatment with lower doses of CyA and prednisolone or CyA alone. The mean follow-up of the second part of the study was 26 +/- 16 months and 18 +/- 7 months, respectively.Results. After 12 months of treatment, 26 patients in the combination group and 17 patients in the monotherapy group had a CR or PR of proteinuria (P = NS). Renal function was unchanged in the two groups. During long-term treatment relapses were more frequent in the monotherapy group (47 vs 15%, P < 0.05). Daily CyA dose was higher in non-relapsers in both groups (combination 1.4 +/- 0.5 vs 1.0 +/- 0.3 mg/kg, P < 0.001, monotherapy 1.5 +/- 0.4 vs 1.1 +/- 0.2 mg/kg, P < 0.003). Relapsers in both groups had lower CyA trough levels (72 +/- 48 ng/ml) compared with non-relapsers (194 +/- 80 ng/ml) (P < 0.03). Renal function and proteinuria remained stable during the follow-up.Conclusion. This study suggests that 12-month therapy with CyA (+/- prednisolone) is effective in inducing remission in most nephrotic patients with MN and well-preserved renal function. Longer treatment with lower doses is a useful approach to maintain remission. Relapses occur more frequently in the monotherapy group and usually are associated with CyA trough levels < 100 ng/ml.