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Pulse cyclophosphamide therapy in steroid-dependent nephrotic syndrome

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Abstract

Intravenous cyclophosphamide (IVCP) has been shown to be effective in lupus nephritis. This is a randomized controlled trial to compare the effectiveness of IVCP with oral cyclophosphamide (OCP) in patients with steroid-dependent (SD) idiopathic nephrotic syndrome (INS). Forty-seven consecutive children who were SD were randomized to receive either OCP (2 mg/kg per day×12 weeks) or IVCP (500 mg/m2 per month IV×6 months) after achieving a steroid-induced remission. The response was evaluated in terms of remission, change in steroid response status, duration of remission (i.e., proteinuria-free days), side effects, and compliance. Of the 47, IVCP was given to 26 children and OCP to 21 children. The demographic data, histopathology, biochemical profile, and duration of follow-up in the two groups were similar. On Kaplan-Meier survival analysis, the median proteinura-free time was 360±88 days compared with 96±88 days in the OCP group (values median±SE, log rank P=0.05). The actuarial cumulative sustained remission in our study was 73% in IVCP compared with 38.1% in OCP at 6 months after therapy, but was almost identical (18.6% in IVCP vs. 19%in OCP) after 2 years. Thus in our study the overall improvement in steroid response category from SD to sustained remission, infrequent relapser, and frequent relapser (88% in IVCP vs. 57% in OCP) was significantly better in the IVCP group, although the number of children with persistent remission tended to be similar at 2 years. Furthermore, the response was observed with a 40% lower cumulative dose than OCP. Hence, we conclude that IVCP is a safe and effective therapeutic modality in children with INS who are SD.

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Authors and Affiliations

  1. Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India

    Narayan Prasad, Sanjeev Gulati, Raj Kumar Sharma & Uttam Singh

  2. Department of Biostatistics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India

    Muffazal Ahmed

  3. Department of Pediatric Nephrology, McMaster University, 1200 Main Street West, Hamilton, Ontario, L8S 2Z5, Canada

    Sanjeev Gulati

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  1. Narayan Prasad
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  2. Sanjeev Gulati
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  3. Raj Kumar Sharma
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  4. Uttam Singh
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  5. Muffazal Ahmed
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Correspondence to Sanjeev Gulati.

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Prasad, N., Gulati, S., Sharma, R.K. et al. Pulse cyclophosphamide therapy in steroid-dependent nephrotic syndrome. Pediatr Nephrol 19, 494–498 (2004). https://doi.org/10.1007/s00467-003-1404-x

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  • DOI: https://doi.org/10.1007/s00467-003-1404-x

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