Treatment with tacrolimus and prednisolone is preferable to intravenous cyclophosphamide as the initial therapy for children with steroid-resistant nephrotic syndrome
Kidney International, 07/11/2012
Exclusive author commentary
Gulati A et al. – Tacrolimus and prednisolone are effective, safe, and preferable to cyclophosphamide as the initial therapy for patients with steroid–resistant nephrotic syndrome.
Arvind Bagga (07/15/2012) comments:
There is need for safe and effective evidence based therapies for patients with steroid resistant nephrotic syndrome. This multicenter, randomized controlled study compared 12-months' therapy with tacrolimus to 6-monthly infusions of IV cyclophosphamide in 131 consecutive children with minimal change disease and focal segmental glomerulosclerosis. Patients receiving tacrolimus showed significantly higher rates of complete remission at 6-months, and favorable outcome at 12 months. Treatment withdrawal due to systemic infections was higher in patients receiving IV cyclophosphamide. Compared to cyclophosphamide, 3 patients required treatment with tacrolimus to achieve one additional remission. For patients with steroid resistant nephrotic syndrome, therapy with tacrolimus and prednisolone is effective and safe, and preferred to cyclophosphamide. Results of this study enable standardization of care for this difficult disease.