Efficacy of Cyclophosphamide versus Cyclosporine in Frequent Relapse Nephrotic Syndrome – A Hospital Based Study

Abstract

Introduction: The clinical outcome of patients with Frequent Relapse Nephrotic Syndrome (FRNS) or Steroid Dependent Nephrotic Syndrome (SDNS) treated with cyclophosphamide or cyclosporine (CsA) is yet to be established. This study was carried out to compare the efficacy of CsA with cyclophosphamide in patients with FRNS or SDNS. Materials and Methods : A total of 54 FRNS or SDNS children were randomly enrolled in this prospective study from August 2013 to July 2014. All the study subjects were treated with prednisolone 60 mg/m 2 /day until the patients were in remission for three consecutive days. The patients were then randomly divided into two groups (Group-A & Group-B). Group-A was treated with cyclophosphamide at a dose of 2.5 mg/kg/day for 60 days, along with tapering dose prednisolone for 8 weeks. The Group-B study population was treated with cyclosporine at a dose of 3 mg/kg/day for 6 months or longer along with tapering dose of alternate day prednisolone for the initial 8 weeks. Four patients in Group-B and one patient in Group-A did not continue the treatment. So, we followed-up 49 children during this period. Results: The efficacy of both drugs was good after 6 months of treatment. Remission was observed in 80% of the cases in Group-A and 79% of the cases in Group-B. Even after 6 months of treatment 6.7% and 10.5% of the patients with SDNS in Group-A and Group-B needed to continue corticosteroid therapy, respectively. The side effects of immunosuppressive therapy were more frequently observed in Group-B patients. On the other hand, the mean serum creatinine level after 6 months therapy was 0.55±0.21mg/dl in Group-A and 0.84±0.43 mg/dl in Group-B. The difference between the two groups was statistically significant (p<0.05). Conclusions: This study showed that both drugs were effective in FRNS and SDNS. Keywords: Child; Nephrotic syndrome; Cyclophosphamide; Cyclosporine.