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Association of initial prednisolone dose with remission, relapse, and infectious complications in adult-onset minimal change disease

BACKGROUND: A dose of 0.5–1 mg/kg/day of prednisolone (PSL) is administered for the initial treatment of minimal change disease (MCD). However, little is known about the optimal PSL dose for the initial treatment of MCD. METHODS: We conducted a retrospective multicenter cohort study of treatment-nai...

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Autores principales: Tanabe, Kaori, Samejima, Ken-ichi, Fukata, Fumihiro, Kosugi, Takaaki, Tsushima, Hideo, Morimoto, Katsuhiko, Okamoto, Keisuke, Matsui, Masaru, Eriguchi, Masahiro, Maruyama, Naoki, Akai, Yasuhiro, Tsuruya, Kazuhiko
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Singapore 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8738364/
https://www.ncbi.nlm.nih.gov/pubmed/34365595
http://dx.doi.org/10.1007/s10157-021-02119-3
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author Tanabe, Kaori
Samejima, Ken-ichi
Fukata, Fumihiro
Kosugi, Takaaki
Tsushima, Hideo
Morimoto, Katsuhiko
Okamoto, Keisuke
Matsui, Masaru
Eriguchi, Masahiro
Maruyama, Naoki
Akai, Yasuhiro
Tsuruya, Kazuhiko
author_facet Tanabe, Kaori
Samejima, Ken-ichi
Fukata, Fumihiro
Kosugi, Takaaki
Tsushima, Hideo
Morimoto, Katsuhiko
Okamoto, Keisuke
Matsui, Masaru
Eriguchi, Masahiro
Maruyama, Naoki
Akai, Yasuhiro
Tsuruya, Kazuhiko
author_sort Tanabe, Kaori
collection PubMed
description BACKGROUND: A dose of 0.5–1 mg/kg/day of prednisolone (PSL) is administered for the initial treatment of minimal change disease (MCD). However, little is known about the optimal PSL dose for the initial treatment of MCD. METHODS: We conducted a retrospective multicenter cohort study of treatment-naive adult patients with MCD diagnosed by renal biopsy from 1981 to 2015 in whom PSL monotherapy was performed as the initial treatment. The exposure of interest was an initial median PSL dose of < 0.63 mg/kg/day (Group L) compared to ≥ 0.63 mg/kg/day (Group H). Cumulative remission and relapse after remission were compared between these groups using Cox regression adjusted for baseline characteristics. RESULTS: Ninety-one patients met the inclusion criteria. During a median follow-up of 2.98 years, 87 (95.6%) patients achieved complete remission, and 47.1% relapsed after remission. There was no significant difference in the remission rate between the groups at 4 weeks of follow-up (66.7 vs. 82.6%). The median time to remission in Group L was comparable to that in Group H (17.0 vs. 14.0 days). A multivariable Cox hazard model revealed that the initial PSL dose was not a significant predictor of remission. The cumulative steroid doses at 6 months, 1 year, and 2 years after treatment initiation were significantly lower in Group L than in Group H. CONCLUSION: The initial PSL dose was not associated with time to remission, remission rate, time to relapse, or relapse rate. Therefore, a low initial steroid dose may be sufficient to achieve remission. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10157-021-02119-3.
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spelling pubmed-87383642022-01-20 Association of initial prednisolone dose with remission, relapse, and infectious complications in adult-onset minimal change disease Tanabe, Kaori Samejima, Ken-ichi Fukata, Fumihiro Kosugi, Takaaki Tsushima, Hideo Morimoto, Katsuhiko Okamoto, Keisuke Matsui, Masaru Eriguchi, Masahiro Maruyama, Naoki Akai, Yasuhiro Tsuruya, Kazuhiko Clin Exp Nephrol Original Article BACKGROUND: A dose of 0.5–1 mg/kg/day of prednisolone (PSL) is administered for the initial treatment of minimal change disease (MCD). However, little is known about the optimal PSL dose for the initial treatment of MCD. METHODS: We conducted a retrospective multicenter cohort study of treatment-naive adult patients with MCD diagnosed by renal biopsy from 1981 to 2015 in whom PSL monotherapy was performed as the initial treatment. The exposure of interest was an initial median PSL dose of < 0.63 mg/kg/day (Group L) compared to ≥ 0.63 mg/kg/day (Group H). Cumulative remission and relapse after remission were compared between these groups using Cox regression adjusted for baseline characteristics. RESULTS: Ninety-one patients met the inclusion criteria. During a median follow-up of 2.98 years, 87 (95.6%) patients achieved complete remission, and 47.1% relapsed after remission. There was no significant difference in the remission rate between the groups at 4 weeks of follow-up (66.7 vs. 82.6%). The median time to remission in Group L was comparable to that in Group H (17.0 vs. 14.0 days). A multivariable Cox hazard model revealed that the initial PSL dose was not a significant predictor of remission. The cumulative steroid doses at 6 months, 1 year, and 2 years after treatment initiation were significantly lower in Group L than in Group H. CONCLUSION: The initial PSL dose was not associated with time to remission, remission rate, time to relapse, or relapse rate. Therefore, a low initial steroid dose may be sufficient to achieve remission. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10157-021-02119-3. Springer Singapore 2021-08-07 2022 /pmc/articles/PMC8738364/ /pubmed/34365595 http://dx.doi.org/10.1007/s10157-021-02119-3 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Original Article
Tanabe, Kaori
Samejima, Ken-ichi
Fukata, Fumihiro
Kosugi, Takaaki
Tsushima, Hideo
Morimoto, Katsuhiko
Okamoto, Keisuke
Matsui, Masaru
Eriguchi, Masahiro
Maruyama, Naoki
Akai, Yasuhiro
Tsuruya, Kazuhiko
Association of initial prednisolone dose with remission, relapse, and infectious complications in adult-onset minimal change disease
title Association of initial prednisolone dose with remission, relapse, and infectious complications in adult-onset minimal change disease
title_full Association of initial prednisolone dose with remission, relapse, and infectious complications in adult-onset minimal change disease
title_fullStr Association of initial prednisolone dose with remission, relapse, and infectious complications in adult-onset minimal change disease
title_full_unstemmed Association of initial prednisolone dose with remission, relapse, and infectious complications in adult-onset minimal change disease
title_short Association of initial prednisolone dose with remission, relapse, and infectious complications in adult-onset minimal change disease
title_sort association of initial prednisolone dose with remission, relapse, and infectious complications in adult-onset minimal change disease
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8738364/
https://www.ncbi.nlm.nih.gov/pubmed/34365595
http://dx.doi.org/10.1007/s10157-021-02119-3
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