Clinical efficacy of tacrolimus/mycophenolate mofetil combined with steroid on children with nephrotic syndrome

Objective To compare the clinical efficacy of tacrolimus (FK506) and mycophenolate mofetil (MMF) combined with steroid respectively in the treatment of steroid dependent/frequent relapsing nephrotic syndrome (SDNS/FRNS) in children. Methods Forty-nine cases of Children with SDFN/SDNS from January, 2009 to July, 2015 were recruited, 21 cases in tacrolimus group, 28 cases in mycophenolate mofetil group, and the 28 cases were divided to MMFlow-concentration group[MPA-AUC < 30 μg/(ml·h)]and MMF-high-concentration group[MPA-AUC ≥ 30 μg/(ml·h)]according to the area under the curve of mycophenolic acid (MPA-AUC). The therapeutic effect of the groups were compared. Results (1) Steroid dosage:The steroid dose was reduced more significantly at 6-month follow-up (P <0. 01). The MMF-high-concentration group's was reduced the most, and it had significant difference compared with MMFlow-concentration group (P < 0. 05). No significant difference among the groups hormone dosage at 12-month follow-up (P > 0. 05). (2) Relapse episodes:The number of relapse episodes was reduced more significantly at 6-month follow-up (P < 0. 05) except MMF-low-concentration group. MMF-low-concentration group had the most number of relapse episodes during 6-month follow-up, and the result was significantly compared with MMF-high-concentration group (P < 0. 05). No significant difference occured in the relapse episodes of the groups at 12-month follow-up (P > 0. 05). Conclusion There is no significant difference in the clinical efficacy between FK506 and MMF combined with steroid respectively in the treatment of children with SDNS/FRNS. After 6 months of treatment, MMF-high-concentration can obtain a satisfactory therapeutic effect. For the children receiving low concentration MMF, the clinical effect can be similar with other patients if the disease did not frequently relapse in one year.