Cyclophosphamide versus cyclosporine in children with frequent-relapsing and steroid-dependent nephrotic syndrome in Khartoum State, Sudan

Abstract

Background: in children with frequent-relapsing and steroid-dependent (FR/SD) nephrotic syndrome (NS) remission can be achieved with either cyclophosphamide (CPM) or cyclosporine (CSA).  Our objective was to compare the efficacy and safety of these agents.
Methodology: Records of all children with FR/SD NS who received CPM or CSA at the Pediatric Renal Unit, Soba Hospital, Khartoum, during the period 2005–2015 were retrospectively reviewed. Main outcomes were: remission rate, relapse rate, and renal outcome.
Results: We studied 82 children with FR/SD NS treated with CPM (59.8%) or CSA (40.2%).
Males were 69.5% and females 30.5%. The mean admission age was 5 ± 3.10 years. At 6 months, 77.6% children on CPM and 60.3% on CSA were in complete remission (CR), (P=0.012) whereas 22.4% versus 39.4% relapsed respectively (P=0.012). At 12 months, 57.5% on CPM and 72.7% on CSA were in CR, (P=0.013) whereas 42.5% versus 27.3% relapsed respectively, (P=0.013). At
24 months, 16.6% on CPM and 29% on CSA were in CR, (P=0.030) whereas 83.4% versus 71% relapsed respectively, (P=0.030). The mean number of relapses per 24 months were 1.7± 0.86 in CPM group versus 2.2 ±0.85 in CSA group, (P=0.72). Mild complications were recorded in 12.4% of patients on CPM group versus 33.3% on CSA, (P=0.031). At the latest follow- up, there was no
significant change from basal levels of TWBC, mean serum creatinine, GFR, or BMI, (P>0.05 for
all parameters).
Conclusion: In children with FR/SD NS, both CPM and CSAwere effective and safe in achieving remission with less risk of serious side- effects. However, long-term remission was less stable with both agents.