Relapse treatment with low-dose steroids in steroid-sensitive minimal change disease

Irene Martín Capón, Eduardo Gutierrez, Ana Huerta, Elizabeth R. Viera, Marta Álvarez Nadal, Milagros Fernández-Lucas, Javier Villacorta
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Abstract

The treatment of minimal change disease (MCD) consists of a high dose of steroids for several months, implying significant drug toxicity. Nevertheless, relapses of steroid-sensitive MCD usually respond to lower doses of steroids.The objective of this study was to analyze whether a low dose of steroids (LDS) is effective for the treatment of MCD relapses. Since 2018, new relapses of steroid-sensitive adult patients with MCD in three Spanish centers have been treated with LDS. The cumulative dose of steroids, the time to remission, and the relapse-free time were compared between relapses treated with LDS and previous relapses of the same patients treated with a standard dose of steroids (SDS).A total of 51 relapses in 31 patients were treated with LDS and compared with 48 historical relapses of the same patients treated with SDS. The mean doses of prednisone adjusted by weight for the initial treatment were 0.45 mg/kg (0.40–0.51 mg/kg) in the relapses treated with LDS and 0.88 mg/kg (0.81–1.00 mg/kg) in those treated with SDS. The mean cumulative doses of prednisone in LDS- and SDS-treated relapses were 1,191 mg (801–1,890 mg) and 3,700 mg (2,755–5,800 mg), respectively. The duration of treatment was 63 days (42–117 days) in the LDS group and was 140 days (65–195 days) in the SDS group. All patients achieved complete remission within 1 month after steroid therapy in both groups. The times to remission of the LDS and SDS groups were 19.10 ± 12.80 and 18.93 ± 12.98 days, respectively (p = 0.95).Among the steroid-sensitive patients with MCD, relapse therapy with LDS (0.5 mg/kg) appears effective and allows minimization of the steroid cumulative dose.
用小剂量类固醇治疗对类固醇敏感的微小病变的复发
微小病变(MCD)的治疗包括连续数月使用大剂量类固醇,这意味着药物毒性很大。然而,对类固醇敏感的MCD复发通常会对较低剂量的类固醇产生反应。本研究旨在分析低剂量类固醇(LDS)是否能有效治疗MCD复发。自2018年以来,西班牙三个中心对类固醇敏感的成年MCD患者的新复发进行了低剂量类固醇治疗。对接受LDS治疗的复发患者的类固醇累积剂量、缓解时间和无复发时间与接受标准剂量类固醇(SDS)治疗的同一患者的既往复发情况进行了比较。在接受LDS治疗的复发患者中,按体重调整的泼尼松初始治疗平均剂量为0.45毫克/千克(0.40-0.51毫克/千克),而在接受SDS治疗的复发患者中,泼尼松初始治疗平均剂量为0.88毫克/千克(0.81-1.00毫克/千克)。在接受LDS和SDS治疗的复发患者中,泼尼松的平均累积剂量分别为1,191毫克(801-1,890毫克)和3,700毫克(2,755-5,800毫克)。LDS 组的治疗时间为 63 天(42-117 天),SDS 组为 140 天(65-195 天)。两组患者均在类固醇治疗后 1 个月内达到完全缓解。LDS 组和 SDS 组的缓解时间分别为 19.10 ± 12.80 天和 18.93 ± 12.98 天(P = 0.95)。
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