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Efficacy and safety of tacrolimus combined with low-dose glucocorticoids versus high-dose glucocorticoids in initial treatment of adult-onset minimal change disease : a retrospective cohort study

internal-medicine
nephrology
urology

Abstract

Background. The treatment of adult minimal change disease (MCD) faces critical challenges due to the side effects of high-dose and long-term glucocorticoid therapy as well as the frequent recurrence of the disease. Clinically, there is a pressing demand for regimens that ensure rapid response and lower relapse rates—calcineurin inhibitors could fulfill this role. This study aims to compare the efficacy and safety of tacrolimus combined with low-dose glucocorticoids versus high-dose glucocorticoids in the treatment of newly diagnosed adult MCD.

Methods. A retrospective cohort study was conducted on 59 adult patients diagnosed with MCD via renal biopsy at the Second Affiliated Hospital of Xi'an Jiaotong University, China. Patients were divided into two groups : the glucocorticoids group (GCs group, 39 patients, receiving 1 mg/kg/day prednisone) and the tacrolimus combined with low-dose glucocorticoid group (TAC group, 20 patients, receiving 0.05 mg/kg/day tacrolimus plus 10 mg/day prednisone). Both groups were followed for at least 24 weeks. The primary endpoint was the complete remission rate (CR) at 24 weeks, with secondary endpoints including relapse rates . And adverse events was analysed.

Results. At 24 weeks, CR rates were comparable. TAC demonstrated a clinically significant reduction in cumulative relapse rates (5% vs. 25.6%), with fewer steroid-related complications. GCs incurred higher Cushingoid features (41% vs. 5%). TAC was associated with transient serum creatinine elevation (10% vs. 0%), resolving spontaneously. Longitudinal albumin recovery and eGFR stability were similar between groups.

Conclusions. TAC combined with low-dose glucocorticoids demonstrates comparable efficacy to high-dose GCs in inducing remission for adult-onset MCD, with a more favorable safety profile.

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