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Abstract: FR-PO660

Long-Term Outcomes of Patients Treated With Tacrolimus as First Line Therapy for Minimal Change Disease

Session Information

Category: Glomerular Diseases

  • 1303 Glomerular Diseases: Clinical‚ Outcomes‚ and Trials

Authors

  • Seneschall, Charlotte, Imperial College London, London, London, United Kingdom
  • Dattani, Rakesh, Imperial College London, London, London, United Kingdom
  • Cairns, Tom, Imperial College London, London, London, United Kingdom
  • McAdoo, Stephen Paul, Imperial College London, London, London, United Kingdom
  • Medjeral-Thomas, Nicholas R., Imperial College London, London, London, United Kingdom
  • Griffith, Megan, Imperial College London, London, London, United Kingdom
Background

Steroids are first line treatment for Minimal Change Disease (MCD) but have significant side effects. Increasingly, alternative immunosuppression such as tacrolimus is used, but there is no data on long term outcomes. This single centre retrospective study reviews long-term outcomes of patients treated with tacrolimus as first line therapy for MCD.

Methods

Adult patients with MCD followed up at Imperial College Hospitals NHS Trust were identified from the biopsy database. Clinical data was extracted from records of patients given tacrolimus monotherapy as initial treatment for MCD with >1yr follow up. Statistics were performed using GraphPadPrism.

Results

50 patients had tacrolimus monotherapy as initial MCD treatment from 2004-2021. 21 were female, 29 male; 21 white, 2 Black, 16 Asian & 11 other/not stated. Median age 50.5yrs (17-83). Initial median albumin 13 (5-26), eGFR 90 (10-90). Median follow up 55.5 months (14-162).

44/50 remitted on tacrolimus, median 1 month (0.5-10). 6/50 failed to remit or were intolerant and were then changed to alternative therapy after median time 3.5 months (1-9). In total, 22/44 treated initially with tacrolimus relapsed. 4/44 relapsed on tacrolimus, including 2 noncompliant before relapse. 1 patient was lost to follow up. 39 had tacrolimus weaned or stopped. 17/39 subsequently relapsed: 5 relapsed on weaning & 12 relapsed after stopping. Median time from stopping tacrolimus to relapse was 3 months (1-55).

18/22 patients who relapsed were retreated with tacrolimus monotherapy and all entered remission. 10/18 patients had a 2nd relapse, 6 had a 3rd relapse, 4 had a 4th. There was no significant change in median eGFR for patients only treated with tacrolimus after 1, 3 and 5 years (p=0.73, 0.11, 0.27). No patients reached end stage renal failure.

Conclusion

Tacrolimus is an effective treatment for MCD that avoids steroids' side effects. As for steroids, relapse rates in adults are high. Low therapeutic levels increase relapse risk. Patients who initially respond to tacrolimus re-enter remission after 1st relapse. Subsequent relapse rates remain high. eGFR is generally maintained but should be monitored for individual patients.