Comparative efficacy of mycophenolic acid and cyclosporine A in treatment of children with steroid-dependent nephrotic syndrome

Abstract

   BACKGROUND. Steroid-dependent nephrotic syndrome (SDNS) treatment is still an important problem in pediatric nephrology since the proper use of steroid-sparing agents can reduce the frequency of relapses and avoid steroid toxicity.   THE AIM of our study was to compare the efficacy of cyclosporine A (CsA) and mycophenolic acid (MPA) in children with SDNS.   PATIENTS AND METHODS. We observed 91 children (30 girls, 61 boys) with SDNS in 2015-2020. Age at the disease debut was 3 years [2,1; 5,0]. The age at steroid-sparing therapy debut was 8 years [4,0; 16,0]. All children received standard clinical and laboratory examinations and kidney biopsy.   RESULTS: 25 children were treated with CsA, and 66 children were treated with MPA. The steroid-sparing therapy duration was 36 months [29; 44]. The frequency of relapses before the steroid-sparing therapy onset was 1,32 ± 0,62 (0,5; 4,3)/year, during steroid-sparing therapy it became 0,5 ± 0,58 (0; 2)/year (р < 0,05). Relapse rate in the MPA group was 0,36 ± 0,49 (0; 1,76)/year compared to 0,85 ± 0,66 (0; 2)/year in the CsA group (p < 0,05). Withdrawal of prednisolone was achieved in 44 (48,4 %) children. The relapse-free period during steroid-sparing therapy with steroid withdrawal was 25 months [6; 120]. 15 children (16,5 %) showed long–term stable remission with no immunosuppressive therapy. 14 of them were treated with MPA and only one with CsA (χ2=9,7, р = 0,0021). The remission duration was 7-32,9 months. There were no severe side effects of CsA and MPA requiring discontinuation of therapy.   CONCLUSION: steroid-sparing therapy of SDNS with CsA and MPA significantly reduces relapse frequency. Relapse risk in patients treated with CsA was significantly higher than with MPA. So, it is justified to prescribe MPA as a first-choice immunosuppressive therapy in patients with SDNS.