Abstract: TH-PO153

Tacrolimus as Monotherapy for Relapsing Minimal Change Disease in the Adult Population

Session Information

Category: Glomerular

  • 1005 Clinical Glomerular Disorders

Authors

  • Chan, Anthony Ting Pong, Imperial College Renal and Transplant Centre, London, United Kingdom
  • Cairns, Tom, Imperial College Renal and Transplant Centre, London, United Kingdom
  • Galliford, Jack W., Imperial College Renal and Transplant Centre, London, United Kingdom
  • Pusey, Charles D., Imperial College Renal and Transplant Centre, London, United Kingdom
  • Griffith, Megan, Imperial College Renal and Transplant Centre, London, United Kingdom
Background

Minimal change disease (MCD) in adults is usually steroid responsive but the relapse rate is high, and some patients may develop steroid dependent disease. Tacrolimus has been used for relapsing/ steroid dependent MCD, however, the relapse rate during treatment has not been studied in adult population.

Methods

This is a retrospective cohort study of 27 patients with relapsing MCD treated with tacrolimus from 2011-2017. 21 males and 6 females with average age of 40.7 years old (Range 16- 80 years old). All patients had relapsing disease and 5 of 27 patients were steroid dependent. Prior to treatment with tacrolimus, 16 patients had 1 relapse, 3 patients had 2 relapses and 8 patients had 3 or more relapses. 23 patients had previously been treated with prednisolone alone, 2 patients had cyclophosphamide and prednisolone and 2 patients received cyclosporine and prednisolone.

Results

15 of 27 patients remained in remission after receiving tacrolimus, with an average treatment time of 28 months (Range 3 to 69 months) and all these patients remain on maintenance therapy. 12 of 27 patients had a further relapse after commencing treatment with tacrolimus, average treatment time of 23.6 months (Range 3-65 months). 8 of 12 patients relapsed while still taking tacrolimus, with average treatment time of 21.3 months (Range 5-65 months), but 5 of these 8 patients had sub-therapeutic levels at time of relapse (<5 ng/ml). 4 of 12 patients relapsed after stopping tacrolimus with average time to relapse after stopping of 2.25 months (Range 2-3 months). The average estimated glomerular filtration rate before tacrolimus was 83.9 ml/min/1.73m2 (Range 24-90 ml/min/1.73m2) and during treatment was 85.73 ml/min/1.73m2 (Range 48-90 ml/min/1.73m2).

Conclusion

Tacrolimus is an effective treatment for relapsing MCD in adult. Patients often require long term maintenance treatment with careful drug level monitoring to avoid relapse. In this cohort all patients who had stopped tacrolimus went on to relapse. Retrospective extension of the study cohort is ongoing to investigate the optimal length of treatment with tacrolimus required to prevent future relapse, to facilitate design of a randomised controlled trial.