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25-01-2024 | Nephrotic Syndrome | Original Article

Feasibility of discontinuing immunosuppression in children with idiopathic nephrotic syndrome

Authors: Yoko Sobue, Kentaro Nishi, Koichi Kamei, Yuta Inoki, Kei Osaka, Tomoya Kaneda, Misaki Akiyama, Mai Sato, Masao Ogura, Kenji Ishikura, Akira Ishiguro, Shuichi Ito

Published in: Pediatric Nephrology | Issue 6/2024

Abstract

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.

Graphical abstract

Available only for authorised users

The Japanese Society of Pediatric Nephrology (2020) Clinical guideline for pediatric idiopathic nephrotic syndrome 2020. Shindan To Chiryo-sha, Tokyo (Japanese only)

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Title: Feasibility of discontinuing immunosuppression in children with idiopathic nephrotic syndrome
Authors: Yoko Sobue
Kentaro Nishi
Koichi Kamei
Yuta Inoki
Kei Osaka
Tomoya Kaneda
Misaki Akiyama
Mai Sato
Masao Ogura
Kenji Ishikura
Akira Ishiguro
Shuichi Ito
Publication date: 25-01-2024
Publisher: Springer Berlin Heidelberg
Keywords: Nephrotic Syndrome
Rituximab
Rituximab
Published in: Pediatric Nephrology / Issue 6/2024
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI: https://doi.org/10.1007/s00467-023-06270-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Feasibility of discontinuing immunosuppression in children with idiopathic nephrotic syndrome

Abstract

Background

Methods

Results

Conclusions

Trial registration

Graphical abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Trial registration

Graphical abstract

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