Abstract: TH-PO154
Initial Therapy of Primary FSGS with Calcineurin Inhibitors Decreases Steroid Exposure without Compromising Renal Response
Session Information
- Clinical Glomerular Disorders: FSGS, MN, MCD
November 02, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Glomerular
- 1005 Clinical Glomerular Disorders
Authors
- Ch?vez-Mendoza, Carlos Adrián, National Medical Sciences and Nutrition Institute Salvador Zubirán, Mexico City, Mexico
- Nino-Cruz, Jose Antonio, National Medical Sciences and Nutrition Institute Salvador Zubirán, Mexico City, Mexico
- Correa-Rotter, Ricardo, National Medical Sciences and Nutrition Institute Salvador Zubirán, Mexico City, Mexico
- Mejia-Vilet, Juan M., National Medical Sciences and Nutrition Institute Salvador Zubirán, Mexico City, Mexico
Background
Reduction of corticosteroid exposure has been a relevant focus in the management of glomerular diseases. High-dose glucocorticoid remains first-line therapy in primary FSGS, reserving calcineurin inhibitors (CNI) to patients with resistant disease or contraindication to corticosteroids.
Methods
Observational cohort. Sixty-two patients were segregated into 3 groups: high-dose steroid (n=35), initial CNI+low-dose steroids (n=11), rescue CNI+steroids (n=16). Groups were compared by survival analysis for complete (CR) and partial remission (PR), time to relapse (TTR), doubling of creatinine (DCr), end-stage renal disease (ESRD). Factors associated with each outcome were obtained by Cox-regression.
Results
Median follow-up was 44 months (IQR 24-69). There were no differences in time to CR/PR between steroid and initial CNI group (p=0.592 and p=0.962). Initial CNI group had a shorter time to prednisone taper<10mg and lower cumulative steroids. There were no differences between the groups in TTR, DSCr, and renal survival. Although the rescue-CNI represented a steroid-resistant/dependent population, this group had no differences when compared to steroid and initial CNI groups. No differences in hospitalizations for infectious events between were observed in the three groups. The factors associated with lower renal survival were higher baseline creatinine, proteinuria, and chronicity score in the renal biopsy.
Conclusion
Treatment of FSGS with CNI as a first-line therapy may reduce exposure to steroids with similar response.
Multivariate Cox regression survival curves for partial remission according to the group of induction therapy for primary FSGS.