Chlorambucil Treatment of Frequently Relapsing Nephrotic Syndrome

Grupe, Warren E.; Makker, Sudesh P; Ingelfinger, Julie R.

doi:10.1056/nejm197609302951402

Cited by 103 publications

(25 citation statements)

References 29 publications

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“…Chlorambucil can induce a prolonged steroid-free remission in children with SDNS, and its efficacy is similar to or even better than cyclophosphamide [32]. As with cyclophosphamide, concerns regarding long-term risk of malignancy and infertility limit its prolonged or continuous use.…”

Section: Discussionmentioning

confidence: 99%

The use of steroid-sparing agents in steroid-sensitive nephrotic syndrome

Abeyagunawardena¹,

Dillon²,

Rees³

et al. 2003

Pediatr Nephrol

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Childhood nephrotic syndrome (NS) is frequently characterized by a relapsing course. There is no uniform agreement about the precise stage at which a steroid-sparing agent should be introduced to control the disease. In order to evaluate the treatment strategies and outcome of steroid-sensitive NS over the last 2 decades, a retrospective notes review was undertaken in a cohort of children treated at Great Ormond Street Children's Hospital between 1980 and 2000. From a population of 863 children with NS referred, 509 had frequently relapsing or steroid-dependent disease and 261 children received at least one steroid-sparing agent. Cyclophosphamide was the first choice in 178 patients and in 114 no further steroid-sparing agent was needed. Levamisole was prescribed as the first steroid-sparing agent for 65 children and disease control was achieved in 30%. Cyclosporin A was prescribed in 61 children and sustained remission was induced in 69%. It is concluded that cyclophosphamide is a potent agent in inducing sustained remission in steroid-sensitive NS. Levamisole and cyclosporin A have emerged as attractive steroid-sparing agents. Complications and major side effects of treatment are infrequent but occasionally fatal.

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Section: Discussionmentioning

confidence: 99%

The use of steroid-sparing agents in steroid-sensitive nephrotic syndrome

Abeyagunawardena¹,

Dillon²,

Rees³

et al. 2003

Pediatr Nephrol

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“…These schedules may actually reduce side effects of steroids but cannot completely avoid them. Cyclophosphamide or chlorambucil may in duce prolonged remission in frequent relapsers [32,33], but the results with these agents are less positive in ste roid-dependent patients [34]. Even in the Italian multicenter study, about 40% of the patients treated during an 8-week course with cyclophosphamide showed 1 or more relapses of the nephrotic syndrome within the first 12 months.…”

Section: Commentsmentioning

confidence: 99%

Ciclosporin in Minimal-Change Glomerulopathy and in Focal Segmental Glomerular Sclerosis

Ponticelli

Rivolta

1990

Am J Nephrol

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Results of the available literature and preliminary data of an ongoing multicenter, prospective, randomized Italian trial indicate that ciclosporin (CS), at low doses, may maintain remission of the nephrotic syndrome in most steroid-sensitive patients. In steroid-resistant patients CS may cause either complete or partial remission in about 40% of patients with idiopathic nephrotic syndrome. With doses not exeeding 5 mg/kg/day and careful monitoring of renal and liver function, blood pressure and blood levels, severe side effects can be prevented. Although an extensive use of CS in nephrotic syndrome is still premature, cautious trials may be attempted in patients with steroid toxicity and/or devastating nephrotic syndrome.

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“…This is particularly true of those who are steroid dependent. A substantial number of steroid-dependent nephrotic children require the additional administration of an immunosuppressant, such as cyclophosphamide [3,4], chlorambucil [5,6], and cyclosporin A [7][8][9]. However, the efficacy of such immunosuppressive agents is sometimes limited and the side effects can be serious.…”

Section: Introductionmentioning

confidence: 99%

“…Most previous studies [3][4][5][6][7][8][9] have discussed the short-term results after the administration of these drugs, although their effects were anticipated to continue for long after their use. We therefore examined children treated with immunosuppressants and also analyzed longitudinally children with relapses after the use of immunosuppressants.…”

Section: Introductionmentioning

confidence: 99%

Long-term effects of immunosuppressants in steroid-dependent nephrotic syndrome

Takeda

Ohgushi

Niimura

et al. 1998

Pediatric Nephrology

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In order to elucidate long-term effects of immunosuppressants, we studied 60 children with steroid-dependent nephrotic syndrome who were treated with three immunosuppressants: cyclophosphamide (n=34), chlorambucil (n=11), and cyclosporin A (n=15). Each relapse before and after the administration of immunosuppressants was evaluated longitudinally in terms of the relapse-free period and the maintenance dose of prednisolone required. The median follow-up period after immunosuppressants was 5.2 years (range 0.5-20.3 years). The relapse-free period was significantly longer in all groups after the initiation of immunosuppressants. However, the relapse-free period after subsequent relapses as compared with the previous relapse was longer in the cyclophosphamide group, similar in the chlorambucil group, and shorter in the cyclosporin A group. The prednisolone dosage at relapse was reduced in subsequent relapses after cyclophosphamide and chlorambucil treatment, but tended to be higher in later relapses after the initiation of cyclosporin A. These findings suggest that the effects of cyclophosphamide are long lasting, while those of chlorambucil and cyclosporin A are of short duration. Children who relapse after cyclosporin A treatment may experience a worse relapsing course.

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Chlorambucil Treatment of Frequently Relapsing Nephrotic Syndrome

Cited by 103 publications

References 29 publications

The use of steroid-sparing agents in steroid-sensitive nephrotic syndrome

The use of steroid-sparing agents in steroid-sensitive nephrotic syndrome

Ciclosporin in Minimal-Change Glomerulopathy and in Focal Segmental Glomerular Sclerosis

Long-term effects of immunosuppressants in steroid-dependent nephrotic syndrome

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