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Abstract: FR-OR025

The Effectiveness of a Short-Term Steroid Regimen for Adult Steroid Sensitive Nephrotic Syndrome

Session Information

Category: Glomerular

  • 1005 Clinical Glomerular Disorders

Authors

  • Ozeki, Takaya, Nagoya University Graduate School of Medicine, Nagoya, AICHI-KEN, Japan
  • Katsuno, Takayuki, Nagoya University Graduate School of Medicine, Nagoya, AICHI-KEN, Japan
  • Kato, Sawako, Nagoya University Graduate School of Medicine, Nagoya, AICHI-KEN, Japan
  • Yasuda, Yoshinari, Nagoya University Graduate School of Medicine, Nagoya, AICHI-KEN, Japan
  • Kosugi, Tomoki, Nagoya University Graduate School of Medicine, Nagoya, AICHI-KEN, Japan
  • Tsuboi, Naotake, Nagoya University Graduate School of Medicine, Nagoya, AICHI-KEN, Japan
  • Maruyama, Shoichi, Nagoya University Graduate School of Medicine, Nagoya, AICHI-KEN, Japan
Background

In pediatric patients with steroid sensitive nephrotic syndrome, recent trials have revealed that 2 months short-term steroid regimen (STSR) is not inferior to the extending steroid course. However, the optimal duration of the initial steroid therapy for adult patients remains unclear.

Methods

Adult MCD or FSGS cases (n=35) who had started STSR from Jan. 2015 through Jun. 2016 were included in this study. Control MCD patients (n=140) who were treated with conventional regimen were also enrolled from our retrospective cohort. All patients fulfilled the criteria below: biopsy proven MCD or FSGS, over 20 years old, first time episode of nephrotic syndrome, and complete remission achieved within 4 weeks. The detail of STSR was as below; (1) prednisolone started 0.8-1.0 mg/kg/day as initial dose and continued for 4-6 weeks. (2) reduced to 0.5-0.6 mg/kg/alternative day and continued for 4 weeks. STSR cases were compared with the control patients who were treated with conventional regimen.

Results

Throughout the observation period (median, 469 days), 23 (65.7%) of 35 STSR patients developed at least one relapse. In survival analysis, STSR associated with earlier first relapse (p<0.001, logrank test) but not with frequent relapse (p=0.21, logrank test). Among STSR group, none had symptom of adrenal insufficiency. The cumulative steroid doses during observational period were significantly smaller in patients with STSR than those with conventional regimen (Figure).

Conclusion

Although the timing of the first relapse in STSR group was earlier compared with conventional group, there was no difference in the occurrence of frequent relapse. Furthermore, STSR achieved lower steroid exposure. The present study suggest that STSR could be an effective treatment option for adult steroid sensitive MCD or FSGS.

Funding

  • Commercial Support