CYCLOPHOSPHAMIDE IN IDIOPATHIC NEPHROTIC SYNDROME What is the Optimal Duration of Therapy?

Cyclophosphamide has been shown to be effective in the treatment of idiopathic nephrotic syndrome (INS).It is a drug, however, with well-recognised side-effects, including gonadal toxicity. Thus, it is essential to determine the shortest duration of therapy which will induce sustained remission. This retrospective study compared a 6-week short-course with a 12-week long-course of cyclophosphamide. The shorter treatment was less effective - relapse rate during the first year was 42% for the short-course patients and 8% for those given the long-course. At 42 months, only 21% of the short-course patients were in remission compared with 63% of the long-course group.

Another study on the effects of an 8-week course of cyclophosphamide reportedly yielded results equivalent to the 12-week course. At present, there seems to be no advantage in continuing cyclophosphamide beyond 8 weeks. The authors recommend:

e Cyclophosphamide should be reserved for those patients with INS in whom unacceptable steroid side-effects develop or in whom the disease is difficult to control.

• Cyclophosphamide therapy should be limited to 8 weeks at a dose of 2-3mg/kg/d. • Cyclophosphamide should be initiated after remission has been achieved with prednisone.

Fifty-three patients (age, 3 months-20years) with stl'roid-dependent INS were entered in the study. A short-course of cyclo­phosphamide 3-Smg/kg/d was given to 29 of them f>;r a period of 6 weeks of protein-free urine (mean duration, 6.8

weeks). The other 24 received cyclophosphamide 3-Smg/kg/d for 8 weeks, followed by 1.5-2.5mg/kg/d for another 4 weeks. All patients also received prednisone 50-75mg/m2 on alternate days.

Pennisi, A. et al.: Pediatrics 57: 94& (Jun 1976)

INPHARMA 26th June, 1976 p9