Comparison of treatment options in adults with frequently relapsing or steroid-dependent minimal change disease

Cihan Heybeli, Stephen B. Erickson, Fernando C. Fervenza, Marie C. Hogan, Ladan Zand, Nelson Leung

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Studies comparing all treatment options for frequently-relapsing/steroid-dependent (FR/SD) minimal change disease (MCD) in adults are lacking. Methods: Medical records of 76 adults with FR/SD MCD who were treated with corticosteroids as the first-line therapy were reviewed. Treatment options were compared for the time to relapse, change of therapy and progression (relapse on full-dose treatment). Results: Second-line treatments included rituximab (RTX; n = 13), mycophenolate mofetil (MMF; n = 12), calcineurin inhibitors (CNI; n = 26) and cyclophosphamide (CTX; n = 16). During the second-line treatments, 48 (71.6%) patients relapsed at median 17 (range 2-100) months. The majority of relapses occurred during dose tapering or off drug. Twenty of 65 (30.8%) changed therapy after the first relapse. The median time to relapse after the second line was 66 versus 28 months in RTX versus non-RTX groups (P = 0.170). The median time to change of treatment was 66 and 44 months, respectively (P = 0.060). Last-line treatment options included RTX (n = 8), MMF (n = 4), CNI (n = 3) and CTX (n = 2). Seven (41.2%) patients had a relapse during the last-line treatment at median 39 (range 5-112) months. The median time to relapse was 48 versus 34 months in the RTX versus non-RTX groups (P = 0.727). One patient in the RTX group died presumably of heart failure. No major adverse event was observed. During the median follow-up of 81 (range 9-355) months, no patients developed end-stage renal disease. Conclusions: Relapse is frequent in MCD in adults. Patients treated with RTX may be less likely to require a change of therapy and more likely to come off immunosuppressive drugs.

Original languageEnglish (US)
Pages (from-to)1821-1827
Number of pages7
JournalNephrology Dialysis Transplantation
Volume36
Issue number10
DOIs
StatePublished - Oct 1 2021

Keywords

  • calcineurin inhibitors
  • cyclophosphamide
  • minimal change disease
  • mycophenolate mofetil
  • rituximab

ASJC Scopus subject areas

  • Nephrology
  • Transplantation

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