دورية أكاديمية
Feasibility of discontinuing immunosuppression in children with idiopathic nephrotic syndrome.
| العنوان: | Feasibility of discontinuing immunosuppression in children with idiopathic nephrotic syndrome. |
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| المؤلفون: | Sobue Y; Center for Postgraduate Education and Training, National Center for Child Health and Development, Tokyo, Japan., Nishi K; Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan. nishi-k@ncchd.go.jp., Kamei K; Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan., Inoki Y; Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan.; Department of Pediatrics, Kobe University Graduate School of Medicine, Hyogo, Japan., Osaka K; Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan.; Department of Pediatrics and Developmental Biology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan., Kaneda T; Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan.; Department of Pediatrics and Developmental Biology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan., Akiyama M; Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan.; Department of Pediatrics, Yokohama City University Graduate School of Medicine, Kanagawa, Japan., Sato M; Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan., Ogura M; Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan., Ishikura K; Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan., Ishiguro A; Center for Postgraduate Education and Training, National Center for Child Health and Development, Tokyo, Japan., Ito S; Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan.; Department of Pediatrics, Yokohama City University Graduate School of Medicine, Kanagawa, Japan. |
| المصدر: | Pediatric nephrology (Berlin, Germany) [Pediatr Nephrol] 2024 Jun; Vol. 39 (6), pp. 1825-1835. Date of Electronic Publication: 2024 Jan 25. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Springer International Country of Publication: Germany NLM ID: 8708728 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1432-198X (Electronic) Linking ISSN: 0931041X NLM ISO Abbreviation: Pediatr Nephrol Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: Berlin : Springer International Original Publication: Berlin : Springer International, c1987- |
| مواضيع طبية MeSH: | Nephrotic Syndrome* , Nephrosis, Lipoid*, Child ; Humans ; Rituximab/adverse effects ; Retrospective Studies ; Feasibility Studies ; Immunosuppressive Agents/adverse effects ; Steroids ; Immunosuppression Therapy ; Recurrence |
| مستخلص: | Background: Despite adverse events associated with the long-term use of immunosuppressants, their long-term discontinuation remains challenging in children with idiopathic nephrotic syndrome. Relapse and resumption of immunosuppressants after discontinuation and associated risk factors were analyzed. Methods: This single-center retrospective cohort study included children with frequently relapsing/steroid-dependent nephrotic syndrome (FRNS/SDNS) or steroid-resistant nephrotic syndrome (SRNS) who initiated immunosuppressant treatment between 2010 and 2020. Patients treated with immunosuppressants for less than two years, those with genetic SRNS, and those with continuation of immunosuppressants were excluded. Results: Sixty-eight patients with FRNS/SDNS or SRNS discontinued immunosuppressants. Discontinuation of immunosuppressants was more frequently tried in patients with less relapse on initial immunosuppressants and less rituximab administration. Of 68 patients who discontinued immunosuppressants, 45 (66%) relapsed and 31 (46%) resumed immunosuppressants with a median follow-up of 39.8 months (IQR 24.6-71.2 months) after discontinuation. The relapse-free survival rates were 40.0%, 35.3%, and 35.3% in 1, 2, and 3 years from discontinuation of immunosuppressants, respectively. Relapse on initial immunosuppressants (HR 2.038, 95%CI 1.006-4.128, P = 0.048) and the relapse-free interval before discontinuation of immunosuppressants (HR 0.971, 95%CI 0.944-0.998, P = 0.037) were significant risk factors associated with relapse after the discontinuation of immunosuppressants, adjusting for sex, age at immunosuppressant treatment initiation, SRNS, and rituximab use. Conclusions: Long-term discontinuation of immunosuppressants can be feasible in patients without a relapse on initial immunosuppressants, those with longer relapse-free interval before discontinuation of immunosuppressants, and those without a relapse for one year after discontinuation of immunosuppressants. Trial Registration: Not applicable. (© 2024. The Author(s), under exclusive licence to International Pediatric Nephrology Association.) |
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| فهرسة مساهمة: | Keywords: Frequently relapsing nephrotic syndrome; Pediatric; Relapse; Steroid-resistant nephrotic syndrome; Withdrawal |
| المشرفين على المادة: | 4F4X42SYQ6 (Rituximab) 0 (Immunosuppressive Agents) 0 (Steroids) |
| SCR Disease Name: | Nephrosis, congenital |
| تواريخ الأحداث: | Date Created: 20240125 Date Completed: 20240419 Latest Revision: 20240419 |
| رمز التحديث: | 20240419 |
| DOI: | 10.1007/s00467-023-06270-9 |
| PMID: | 38270600 |
| قاعدة البيانات: | MEDLINE |
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Full Text Finder | تدمد: | 1432-198X |
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| DOI: | 10.1007/s00467-023-06270-9 |