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Abstract: PO1777

Glucocorticoid Toxicity in the Ponticelli Regimen

Session Information

Category: Glomerular Diseases

  • 1202 Glomerular Diseases: Immunology and Inflammation

Authors

  • Huckle, Abby L., Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, United Kingdom
  • Dhaygude, Ajay Prabhakar, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, United Kingdom
Background

Idiopathic membranous nephropathy (IMN) is a immune complex mediated renal disease and the leading cause nephrotic syndrome in non-diabetic adults. Long term relapse data for modern drugs like Calcineurin inhibitors and B-cell therapy are lacking. Modified Ponticelli regime offers 70% relapse free survival for 10 years however toxicity of cyclophosphamide and glucocorticoids(GC) remains major concern. Assessment of GC toxicity has not been assessed in this cohort. This study looked at the GC toxicity of patients in the year following treatment completion1,2

Methods

The glucocorticoid toxicity index (GTI)was calculated for 15 IMN patients treated with modified Ponticelli regime at time of treatment completion(0) and then 6 and 12 months post treatment completion, and compared to a pre-treatment baseline. The total dose of steroids received during treatment was also calculated.

Results

Mean cumulative prednisolone dose was 11.05g. The results at 0,6 and 12 months post completion of the Ponticelli regime for individual patients is shown on the graph. At completion 12/15 patients demonstrated GC toxicity, 7 at 6 months improving to 6/15 at 12 months. Effect on blood pressure (BP) was the most common indicator of GC toxicity at 12 months: 4/15 patients. 6 patients were in negative points at 12 months, due to improvement in weight, BP and lipid levels

Conclusion

Overall apart from BP, only 2/15 patients had evidence of damage due to GC exposure at 12 months in spite of very high cumulative GC doses. This lower level incidence of GC toxicity could be due to less impact on hypothalamo-pitutary axis due to unusual dosing regime of alternating months.
Limitations: Relatively small cohort and retrospective design

1- Ponticelli C, Passerini P. Treatment of the nephrotic syndrome associated with primary glomerulonephritis. KI. 1994;46:595–604
2- Bjorneklett R, Vikse BE, Svarstad E, et al. Long-term risk of cancer in membranous nephropathy patients. Am J Kidney Dis. 2007;50:3:396-403

male: femaleAverage AgeAverage cumulative glucocorticoid doseAverage GTI 0 monthsAverage GTI 6 monthsAverage GTI 12 months
13:254.211.05g227.96.4