Comparison of the effects of intravenous methylprednisolone pulse versus oral prednisolone therapies on the first attack of minimal-change nephrotic syndrome in adults

Aim: Minimal-change nephrotic syndrome (MCNS) is characterized by a good response to corticosteroid, but a high incidence of relapse. We compared the effect of intravenous methylprednisolone pulse plus oral prednisolone therapy (pulse group) with that of conventional oral prednisolone alone therapy (oral group) on the responsiveness and relapse in the first attack of adult-onset MCNS patients. Methods: Eighty-one adult patients with biopsy-proven MCNS, who were previously untreated and admitted to our hospital with their first attack of nephrotic syndrome, were analyzed retrospectively. They were arbitrarily assigned to either pulse group (n = 29, 1000 mg of methylprednisolone intravenously for 3 days, and then oral prednisolone 30 to 40 mg daily for 4 to 8 weeks) or oral group (n = 52, oral prednisolone 1 mg/ kg daily for 4 to 8 weeks). We compared the time to response and relapse between the two groups. Results: Time to steroid response was significantly shorter in the pulse group compared with the oral group (15.2 1 10.2 vs 26.7 1 17.6 days, P = 0.03). In 74 patients who reached remission within 12 weeks (pulse vs oral groups; 86.2% vs 96.2%, ns), the time to relapse was not different between two groups but the relapse rate was significantly higher in the pulse group (pulse vs oral groups; 60% vs 35%, P = 0.038). Kaplan-Meier analyses revealed that both complete remission rates within 4 weeks of the initial steroid therapy and relapse rate within 12 months after attaining remission were significantly higher in the pulse group than the oral group. In the Cox regression model, intravenous methylprednisolone pulse therapy had a significant effect on relapse (hazard ratio, 2.39 (95% confidence interval 1.11-5.15), P = 0.026). Conclusion: Intravenous methylprednisolone pulse followed by oral prednisolone therapy shows an earlier responsiveness but a much more frequent relapse compared with conventional oral prednisolone alone therapy for the first attack of adult-onset MCNS.