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Treatment patterns and steroid dose for adult minimal change disease relapses: A retrospective cohort study.

ABSTRACT:

Background

In patients with adult minimal change disease (MCD), proteinuria relapse is a problem to solve. However, the optimal relapse treatment regimen remains unclear regarding steroid dose. We described the treatment pattern of adult MCD patients and evaluated the appropriate steroid dose for relapse treatment.

Methods

This retrospective multicenter cohort study included 192 patients with adult biopsy-proven MCD from 14 hospitals in Japan. The prescription pattern of immunosuppressive drugs in relapse was reviewed. To assess the association between steroid dose used for relapse and subsequent outcomes, data of patients with tapered prednisolone (PSL) dosage to <10 mg/day before the first relapse in whom the dose was subsequently increased to ?10 mg/day were extracted and assigned to the High-PSL or Low-PSL groups, based on the median dose of 20 mg/day. Multivariate Cox proportional hazard model and propensity score analysis with multiple imputations were conducted to compare their clinical course.

Results

During a median observation period of 37.6 months, 186/192 (96.9%) patients achieved complete remission (CR) and 100 (52.1%) relapsed. The median urinary protein level at the first relapse was 3.12 g/gCr or g/day. The proportion of non-steroidal immunosuppressant use increased with relapses; cyclosporine was the most common. No significant differences were found in the second relapse, frequent relapses, or adverse events between High-PSL (n = 34) and Low-PSL (n = 36) groups. A multivariate Cox proportional hazard model revealed that the hazard ratios adjusted with propensity score for the second relapse were 0.94 (High-PSL vs. Low-PSL; 95% confidence interval, 0.42-2.10; P = 0.88) and 0.82 (PSL dose per 10 mg/day; 95% confidence interval, 0.58-1.16; P = 0.25).

Conclusions

Among patients in CR with PSL dose <10 mg/day, higher steroid dose (PSL >20 mg/day) was not associated with favorable outcomes after the first relapse as compared to lower dose (10-20 mg/day).

SUBMITTER: Ozeki T

PROVIDER: S-EPMC6005527 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

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Publications

Treatment patterns and steroid dose for adult minimal change disease relapses: A retrospective cohort study.

Ozeki Takaya T Ando Masahiko M Yamaguchi Makoto M Katsuno Takayuki T Kato Sawako S Yasuda Yoshinari Y Tsuboi Naotake N Maruyama Shoichi S

PloS one 20180618 6

<h4>Background</h4>In patients with adult minimal change disease (MCD), proteinuria relapse is a problem to solve. However, the optimal relapse treatment regimen remains unclear regarding steroid dose. We described the treatment pattern of adult MCD patients and evaluated the appropriate steroid dose for relapse treatment.<h4>Methods</h4>This retrospective multicenter cohort study included 192 patients with adult biopsy-proven MCD from 14 hospitals in Japan. The prescription pattern of immunosup ...[more]

PMID: 29912938

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Project description:Rationale & objectiveThe response to corticosteroid therapy may differ among patients with minimal change disease (MCD). Previous studies have suggested that glomerular hypertrophy or low areal glomerular density in biopsy specimens, which may be related to fewer nephrons, is associated with such a difference. We examined the associations between nephron number and the therapeutic response to corticosteroids in patients with MCD.Study designRetrospective cohort study.Setting & participants75 adult patients with a histologic diagnosis of MCD.ExposureNephron number per kidney estimated based on the combination of unenhanced computed tomography and nonsclerotic volumetric glomerular density in kidney biopsy specimens.OutcomesComplete remission and relapse following corticosteroid therapy.Analytical approachMultivariable Cox proportional hazard analyses of associations between factors, including nephron number, and outcomes.ResultsMean age of patients was 45.9 years and 60.0% were men. Patients had an estimated glomerular filtration rate of 64.6 mL/min/1.73 m2 and proteinuria of 8.7 g/d. The estimated total number of nonsclerotic glomeruli ranged from 1.07 to 18.77 ×105 per kidney among all patients. There were no significant differences in total amounts or selectivity of urinary protein excretion at biopsy among the tertile groups categorized by nephron number. All patients responded to corticosteroid therapy, but those with fewer nephrons had a delayed achievement of complete remission. Multivariable Cox proportional hazard analyses identified nephron number as a significant independent explanatory variable for the achievement of complete remission, with a hazard ratio of 1.10 (95% CI, 1.02-1.19)/100,000 nephrons per kidney. Nephron number in these patients was not associated with achievement of partial remission or relapse following complete remission.LimitationRetrospective design and sampling bias of needle biopsy.ConclusionsA small nephron number in patients with MCD is associated with longer time to complete remission.

Dataset Information

Treatment patterns and steroid dose for adult minimal change disease relapses: A retrospective cohort study.

Background

Methods

Results

Conclusions

Publications

Treatment patterns and steroid dose for adult minimal change disease relapses: A retrospective cohort study.

Similar Datasets

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