Maki Shinzawa1, Ryohei Yamamoto1, Yasuyuki Nagasawa1, Susumu Oseto2, Daisuke Mori3, Kodo Tomida4, Terumasa Hayashi5, Masaaki Izumi4, Megumu Fukunaga2, Atsushi Yamauchi3, Yoshiharu Tsubakihara6, Yoshitaka Isaka7. 1. Departments of Geriatric Medicine and Nephrology, and. 2. Division of Nephrology, Department of Internal Medicine, Toyonaka Municipal Hospital, Toyonaka, Japan; 3. Division of Nephrology, Department of Internal Medicine, Osaka Rosai Hospital, Sakai, Osaka, Japan; 4. Department of Internal Medicine, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan; and. 5. Department of Kidney Disease and Hypertension, Osaka General Medical Center, Osaka, Japan. 6. Department of Kidney Disease and Hypertension, Osaka General Medical Center, Osaka, Japan Comprehensive Kidney Disease Research, Osaka University Graduate School of Medicine, Suita, Osaka, Japan; 7. Departments of Geriatric Medicine and Nephrology, and isaka@kid.med.osaka-u.ac.jp.
Abstract
BACKGROUND AND OBJECTIVES: Previous studies suggested that intravenous methylprednisolone possibly accelerates remission of proteinuria in adult-onset minimal change disease; its impact on relapse of proteinuria is unknown. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This multicenter retrospective cohort study included 125 adult-onset minimal change disease patients diagnosed by kidney biopsy between 2000 and 2009 and treated initially with corticosteroid in five nephrology centers in Japan participating in the Study of Outcomes and Practice Patterns of Minimal Change Disease. Times to first remission and first relapse of proteinuria after initiating the first immunosuppressive therapy were compared between 65 patients with initial use of intravenous methylprednisolone followed by prednisolone and 60 patients with initial use of prednisolone alone using multivariate Cox proportional hazards models. After calculating the probability of receiving methylprednisolone and prednisolone using a logistic regression model (propensity score), the results were ascertained using propensity score-matched and -stratified models. RESULTS: During the median 3.6 years of observation (interquartile range=2.0-6.9), all 65 patients in the methylprednisolone and prednisolone group achieved remission within 11 (8-20) days of the corticosteroid initiation, whereas in the prednisolone group, 58 of 60 patients (96.7%) achieved remission within 19 (12-37) days (P<0.001). After achieving first remission, 32 (49.2%) patients in the methylprednisolone and prednisolone group and 43 (74.1%) patients in the prednisolone group developed at least one relapse. Multivariate Cox proportional hazards models revealed that methylprednisolone and prednisolone use was significantly associated with early remission (multivariate-adjusted hazard ratio, 1.56; 95% confidence interval, 1.06 to 2.30) and lower incidence of relapse (0.50; 95% confidence interval, 0.29 to 0.85) compared with prednisolone use alone. These results were ascertained in propensity score-based models. No significant difference was observed in incidence of adverse events, including infection, aseptic osteonecrosis, cataract, diabetes, and gastrointestinal bleeding. CONCLUSIONS: Initial use of methylprednisolone was associated with earlier remission and lower incidence of relapse in adult-onset minimal change disease patients. Efficacy of methylprednisolone should be evaluated in randomized controlled trials.
BACKGROUND AND OBJECTIVES: Previous studies suggested that intravenous methylprednisolone possibly accelerates remission of proteinuria in adult-onset minimal change disease; its impact on relapse of proteinuria is unknown. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This multicenter retrospective cohort study included 125 adult-onset minimal change diseasepatients diagnosed by kidney biopsy between 2000 and 2009 and treated initially with corticosteroid in five nephrology centers in Japan participating in the Study of Outcomes and Practice Patterns of Minimal Change Disease. Times to first remission and first relapse of proteinuria after initiating the first immunosuppressive therapy were compared between 65 patients with initial use of intravenous methylprednisolone followed by prednisolone and 60 patients with initial use of prednisolone alone using multivariate Cox proportional hazards models. After calculating the probability of receiving methylprednisolone and prednisolone using a logistic regression model (propensity score), the results were ascertained using propensity score-matched and -stratified models. RESULTS: During the median 3.6 years of observation (interquartile range=2.0-6.9), all 65 patients in the methylprednisolone and prednisolone group achieved remission within 11 (8-20) days of the corticosteroid initiation, whereas in the prednisolone group, 58 of 60 patients (96.7%) achieved remission within 19 (12-37) days (P<0.001). After achieving first remission, 32 (49.2%) patients in the methylprednisolone and prednisolone group and 43 (74.1%) patients in the prednisolone group developed at least one relapse. Multivariate Cox proportional hazards models revealed that methylprednisolone and prednisolone use was significantly associated with early remission (multivariate-adjusted hazard ratio, 1.56; 95% confidence interval, 1.06 to 2.30) and lower incidence of relapse (0.50; 95% confidence interval, 0.29 to 0.85) compared with prednisolone use alone. These results were ascertained in propensity score-based models. No significant difference was observed in incidence of adverse events, including infection, aseptic osteonecrosis, cataract, diabetes, and gastrointestinal bleeding. CONCLUSIONS: Initial use of methylprednisolone was associated with earlier remission and lower incidence of relapse in adult-onset minimal change diseasepatients. Efficacy of methylprednisolone should be evaluated in randomized controlled trials.
Authors: Philippe Grimbert; Vincent Audard; Philippe Remy; Philippe Lang; Djillali Sahali Journal: Nephrol Dial Transplant Date: 2003-02 Impact factor: 5.992
Authors: S Doublier; V Ruotsalainen; G Salvidio; E Lupia; L Biancone; P G Conaldi; P Reponen; K Tryggvason; G Camussi Journal: Am J Pathol Date: 2001-05 Impact factor: 4.307
Authors: E Imbasciati; R Gusmano; A Edefonti; P Zucchelli; C Pozzi; C Grassi; M Della Volpe; F Perfumo; P Petrone; M Picca Journal: Br Med J (Clin Res Ed) Date: 1985-11-09
Authors: Nicholas Rhys Medjeral-Thomas; Christopher Lawrence; Marie Condon; Bhrigu Sood; Paul Warwicker; Heather Brown; James Pattison; Sunil Bhandari; Jonathan Barratt; Neil Turner; H Terence Cook; Jeremy B Levy; Liz Lightstone; Charles Pusey; Jack Galliford; Thomas D Cairns; Megan Griffith Journal: Clin J Am Soc Nephrol Date: 2020-01-17 Impact factor: 8.237
Authors: Hajeong Lee; Kyung Don Yoo; Yun Kyu Oh; Dong Ki Kim; Kook-Hwan Oh; Kwon Wook Joo; Yon Su Kim; Curie Ahn; Jin Suk Han; Chun Soo Lim Journal: Medicine (Baltimore) Date: 2016-03 Impact factor: 1.889