Cyclosporin treatment of IgA nephropathy: a short term controlled trial.

Lai, Kar Neng; Lai, Fernand Mac‐Moune; Li, Philip K.T.; Vallance‐Owen, J.

doi:10.1136/bmj.295.6607.1165

Cited by 73 publications

(36 citation statements)

References 13 publications

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“…55,56 None of the evidence is sufficient at present to suggest their use in IgAN patients. Of note, as discussed below, neither cyclosporine A, tacrolimus, or sirolimus prevent recurrence of IgAN in a renal graft.…”

Section: Other Immunosuppressive Monotherapy Approaches Are Not Estabmentioning

confidence: 99%

Current Therapy for IgA Nephropathy

Floege

Eitner

2011

Journal of the American Society of Nephrology

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Section: Other Immunosuppressive Monotherapy Approaches Are Not Estabmentioning

confidence: 99%

Current Therapy for IgA Nephropathy

Floege

Eitner

2011

Journal of the American Society of Nephrology

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“…ИТ даёт преимущества, так как действует на не-сколько звеньев патогенеза, но всегда следует учитывать её токсические эффекты. Целевые Т-клеточные препараты, например циклоспо-рин, могут уменьшить ПУ в комбинации с ГК посредством клубочковой вазоконстрикции, но они ухудшают клубочковую фильтрацию [49].…”

Section: казанский медицинский журнал 2017 г том 98 №5unclassified

Modern classification, progression factors, treatment and outcomes of primary mesangial proliferative glomerulonephritis

et al. 2017

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The choice of treatment of mesangial proliferative glomerulonephritis (post-infection, immunoglobulin A, G and M nephritis) is performed taking into account the remission achievement, slowing of progression and reduction of the risk of recurrences of glomerulonephritis. The efficiency of etiologic factor removing is debatable: glomerulonephritis associated with infections usually resolves after their elimination; individual patients achieve immunoglobulin A nephritis remission with persistent antimicrobial treatment of focal infection, but surgical removal of the focus (tonsillectomy) does not affect the long-term prognosis, therefore it is not recommended. Treatment of immunoglobulin A nephritis with oral prednisone for up to 4 months, sometimes in combination with cyclophosphamide (cyclophosphane), reduces the likelihood of its relapse. At low risk of progression of immunoglobulin A nephritis with proteinuria less than 1 g/day, long-term therapy with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers is indicated with administration of maximum tolerated doses for proteinuria more than 1 g/day. Also fish oil 3 g/day is administered for up to 2 years. If proteinuria more than 1 g/day persists for 3-6 months, corticosteroids are recommended for 6 months. With mild renal dysfunction, corticosteroids are prescribed orally or in pulse-therapy with high doses intravenously and maintenance therapy with low doses orally. Immunosuppressive therapy - cyclophosphamide, cyclosporine, azathioprine, mycophenolate mofetil - in combination with corticosteroids is indicated in rapid loss of renal function or massive/moderate proteinuria. In minimal proteinuria immunosuppressive therapy is considered to be unreasonable. Use of intravenous immunoglobulin for immunoglobulin A nephritis from the point of view of lesser toxic effect is possible only as the induction therapy. Currently, there are no clinical recommendations for the treatment of immunoglobulin M nephritis, in case of nephrotic syndrome, corticosteroids are the drugs of the 1st line. There are isolated studies of the use of cyclophosphamide, mycophenolate mofetil, and cyclosporine, with the achievement of remission in frequent relapses of nephrotic syndrome or steroid drug resistance. The cases of immunoglobulin M nephritis treates with retuximab with a positive effect are described. The effectiveness of immunoglobulin G nephritis treatment is less studied, the choice of treatment is similar to that of immunoglobulin A and M nephritis.

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“…However, currently, there are few randomized controlled trials (RCTs) of CsA treatment in patients with IgAN. In 1987, Lai et al reported that treatment with CsA (5 mg/kg) effectively reduces proteinuria, increases serum albumin and partially lowers plasma IgA, although, in that study, the serum creatinine (Scr) level increased in association with a decline in glomerular filtration rate (GFR) in the patients with IgAN (15). Since then, a few non-controlled small sample studies have reported that CsA is effective in treating IgAN without causing significant effects on the renal function (16)(17)(18).…”

Section: Introductionmentioning

confidence: 99%

Comparison of Glucocorticoids Alone and Combined with Cyclosporine A in Patients with IgA Nephropathy: A Prospective Randomized Controlled Trial

Liu

Fang

et al. 2014

Intern. Med.

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Objective The aim of this study was to investigate the effects of two different treatment regimes in patients with IgA nephropathy (IgAN): steroids alone and in combination with a medium dose of cyclosporine A (CsA). Methods Forty-eight IgAN patients 18-69 years of age with proteinuria >1.0 g/24 hours and an estimated glomerular filtration rate (eGFR) of >30 mL/min/1.73 m 2 were randomly given either steroids alone (methylprednisolone (MP) group; n=25) or steroids plus CsA treatment (combination group; n=23). The primary endpoint was the reduction of proteinuria by 50% or more of the baseline value. The secondary endpoint was an increase in the baseline serum creatinine level of 50% or a decrease in the baseline eGFR of 25%. Results After 12 months of treatment, all patients in the combination group and 87.50% of the patients in the MP group reached the primary endpoint. The complete remission rates in the combination group and MP group were 50.0% and 45.83%, respectively. The level of urinary protein excretion declined from 3.17 ± 3.25 g/24 hours to 0.36 ± 0.23 g/24 hours (p<0.001) in the combination group and from 2.60 ± 2.03 g/24 hours to 0.53 ± 0.71 g/24 hours (p<0.001) in the MP group. Two patients in the combination group reached the secondary endpoint, with a decrease in the eGFR of 25% from the baseline value, while no patients in the MP group achieved this goal. The patients in the combination group exhibited significant improvements in the eGFR after nine months (90.16 ± 28.78 vs. 80.46 ± 22.73 mL/min.1.73 m 2 , p=0.011), while the patients in the MP group showed significant increases in the eGFR after six months of treatment (92.18 ± 22.71 to 81.63 ± 18.36 mL/min/1.73 m 2 , p=0.019). Four patients (8.33%) developed severe pneumonia during treatment. Conclusion Both the full dose of steroids alone and combined treatment with steroids and a medium dose of CsA remarkably reduced the levels of proteinuria and ameliorated the renal function in the IgAN patients. Infection was the most serious complication during the treatment.

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Cyclosporin treatment of IgA nephropathy: a short term controlled trial.

Cited by 73 publications

References 13 publications

Current Therapy for IgA Nephropathy

Current Therapy for IgA Nephropathy

Modern classification, progression factors, treatment and outcomes of primary mesangial proliferative glomerulonephritis

Comparison of Glucocorticoids Alone and Combined with Cyclosporine A in Patients with IgA Nephropathy: A Prospective Randomized Controlled Trial

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