Prolonged remission after cyclophosphamide or tacrolimus treatment in childhood nephrotic syndrome: a cohort study.

IF 2.6 3区 医学 Q1 PEDIATRICS
Cal H Robinson, Nowrin Aman, Tonny Banh, Josefina Brooke, Rahul Chanchlani, Vaneet Dhillon, Valerie Langlois, Leo Levin, Christoph Licht, Ashlene McKay, Damien Noone, Alisha Parikh, Rachel Pearl, Seetha Radhakrishnan, Veronique Rowley, Chia Wei Teoh, Jovanka H Vasilevska-Ristovska, Rulan S Parekh
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引用次数: 0

Abstract

Background: Steroid-sparing immunosuppression is used in 50% of children with nephrotic syndrome, to prevent relapses and steroid-related toxicity. However, rates and predictors of prolonged remission after cyclophosphamide and tacrolimus are uncertain.

Methods: Retrospective analysis of children (1-18 years) enrolled in a longitudinal cohort. We included children diagnosed with steroid-sensitive nephrotic syndrome between 1996-2019 from Toronto, Canada. The exposure was cyclophosphamide or tacrolimus initiation. The primary outcome was prolonged remission (no further relapse or steroid-sparing immunosuppression). We evaluated predictors of prolonged remission and calcineurin inhibitor nephrotoxicity by logistic regression.

Results: Of 578 children with steroid-sensitive nephrotic syndrome, 252 received cyclophosphamide and 120 received tacrolimus. Over median 5.4-year (IQR 2.4-9.1) follow-up, prolonged remission occurred in 72 (28.6%) after cyclophosphamide and 17 (14.2%) after tacrolimus. Relapse frequency decreased after initiation of either medication. Lower prior relapse rate, more recent treatment era, and female sex were predictive of prolonged remission after cyclophosphamide treatment. Use of tacrolimus as the first steroid-sparing medication was the only factor predictive of calcineurin inhibitor nephrotoxicity.

Conclusions: Less than one-third of children achieve prolonged remission after initiating cyclophosphamide or tacrolimus, although both reduce short-term relapse rates. Few factors predict prolonged remission after cyclophosphamide or tacrolimus use, or calcineurin inhibitor nephrotoxicity.

儿童肾病综合征患者接受环磷酰胺或他克莫司治疗后病情长期缓解:一项队列研究。
背景:50%的肾病综合征患儿使用类固醇间隔免疫抑制,以防止复发和类固醇相关毒性。然而,环磷酰胺和他克莫司治疗后的长期缓解率和预测因素尚不确定:方法:对参加纵向队列的儿童(1-18 岁)进行回顾性分析。我们纳入了加拿大多伦多在 1996-2019 年间被诊断患有类固醇敏感性肾病综合征的儿童。接触的是环磷酰胺或他克莫司。主要结果是缓解期延长(不再复发或使用类固醇免疫抑制)。我们通过逻辑回归评估了延长缓解期和钙神经蛋白抑制剂肾毒性的预测因素:在578名类固醇敏感肾病综合征患儿中,252名接受了环磷酰胺治疗,120名接受了他克莫司治疗。在中位 5.4 年(IQR 2.4-9.1)的随访中,72 例(28.6%)患儿在接受环磷酰胺治疗后病情缓解时间延长,17 例(14.2%)患儿在接受他克莫司治疗后病情缓解时间延长。开始使用两种药物后,复发频率均有所下降。较低的复发率、较新的治疗时间和女性性别是环磷酰胺治疗后延长缓解期的预测因素。使用他克莫司作为第一种类固醇备用药物是预测钙神经蛋白抑制剂肾毒性的唯一因素:结论:尽管环磷酰胺和他克莫司都能降低短期复发率,但只有不到三分之一的患儿在接受环磷酰胺或他克莫司治疗后获得了长期缓解。很少有因素能预测使用环磷酰胺或他克莫司后缓解时间的延长或钙神经蛋白抑制剂的肾毒性。
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来源期刊
Pediatric Nephrology
Pediatric Nephrology 医学-泌尿学与肾脏学
CiteScore
4.70
自引率
20.00%
发文量
465
审稿时长
1 months
期刊介绍: International Pediatric Nephrology Association Pediatric Nephrology publishes original clinical research related to acute and chronic diseases that affect renal function, blood pressure, and fluid and electrolyte disorders in children. Studies may involve medical, surgical, nutritional, physiologic, biochemical, genetic, pathologic or immunologic aspects of disease, imaging techniques or consequences of acute or chronic kidney disease. There are 12 issues per year that contain Editorial Commentaries, Reviews, Educational Reviews, Original Articles, Brief Reports, Rapid Communications, Clinical Quizzes, and Letters to the Editors.
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