Comparison of first choice cytostatic therapy with calcineurin inhibitors and nucleotides synthesis inhibitors in children with steroid-sensitive, steroid-dependent nephrotic syndrome with steroid toxicity

AIM. Evaluation in comparative study the efficiency of first choice cytostatic therapy with calcineurin inhibitor cyclosporine A and nucleotide synthesis inhibitormycophenolatemofetil (MMF)/mycophenolate sodium in children with relapsing and frequently relapsing steroid-dependent and steroid-sensitive nephrotic syndrome (NS) with steroid toxicity.

PATIENTS AND METHODS. Follow-up study with analysis of onset, clinical course and treatment includes 48 children ((29 boys (60 %) и 19 girls (40 %)) with relapsing and frequently relapsing NS, developedsteroid dependence and/or steroid toxicity.The efficiency of first choice cytostatic therapy with calcineurin inhibitor cyclosporine Ain 17 patients and nucleotide synthesis inhibitormycophenolatemofetil (MMF)/mycophenolate sodium in 31 patients is estimated in comparative study by analysis of 6 month remission rate and one year remission rate after treatment.

RESULTS. Statistically significant differences in 6 month and one year remission rate after first choice cytostatic therapy with MMF/ mycophenolate sodium and cyclosporine in children are established. Remission of NS during 6 months after MMF/ mycophenolate sodium treatment was in 67,7 % (in 21 from 31 patients) unlike of that after cyclosporine – in 29,4 % (in 5 from 17 patients) (р<0,05). Remission of NS during one year after MMF/ mycophenolate sodium treatment was in 58,1 % (in 18 from 31 patients) unlike of that after cyclosporine – 23,5 % (in 4 from 17 patients) (р<0,05). Cyclosporine toxicity was diagnosed in 5 from 17patients: increased creatinine (1),arterial hypertension (3), gingival hyperplasia (3) in treatment more than 12 months with reverse development after cancel. Side-effects after nucleotide synthesis inhibitor therapy was dignosed only in 1 from 31 patients (3,2 %) – lymphopenic crisis.

CONCLUSION. Remission of relapsing and frequently relapsing steroid-dependent and steroid-sensitive with steroid toxicity NS during 6 months after first choice cytostatic therapy with MMF/ mycophenolate sodium and cyclosporine in children was in 67,7 % and 29,4 % respectively, during one year in 58,1 % and 23,5 % respectively. As the result of comparative study remission during 6 months and one year was statistically significant more often in children after first choice cytostatic therapy with MMF/ mycophenolate sodium.

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