A study of Chinese adult patients suggests that a 24-week course of tacrolimus is a favorable steroid-sparing drug for treating steroid-dependent minimal change nephritic syndrome (SD-MCNS).
Researchers at the Kidney Disease Center, The First Affiliated Hospital, Hangzhou, studied 26 patients, of whom 14 received IV cyclophosphamide (750 mg/m2 body surface) and 12 received oral tacrolimus (target trough level of 4-8 ng/mL) for 24 weeks. These medications were administered with prednisone (0.5 mg/kg/day), the dose of which was tapered throughout the study. One patient in each group discontinued treatment because of a drug-related adverse effect.
After the 24-week treatment period, 10 of 13 patients (76.9%) in the cyclophosphamide group achieved complete remission compared with 10 of 11 tacrolimus recipients (90.9%), the investigators reported in Nephrology Dialysis Transplantation (2007;published online ahead of print). The mean time required for complete remission was significantly less in the tacrolimus group.
Eight of 13 cyclophosphamide-treated patients (61.5%) successfully stopped steroids and changed their status from steroid dependence compared with eight of 11 tacrolimus recipients (72.7%).
Additionally, six of the 10 cyclophosphamide-treated (60%) and five of 10 tacrolimus recipients who achieved complete remission maintain remission during the follow-up period of 23 months.