Mycophenolate mofetil/prednisone
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Gastrointestinal disorders and other toxicities in paediatric patients: 3 case reports Three paediatric patients with nephrotic syndrome (NS)* developed various toxicities associated with long-term prednisone therapy [dosage information incomplete; routes, durations of treatment to reaction onsets and some outcomes not stated]. Two patients also developed GI disorders during subsequent treatment with mycophenolate mofetil [routes not stated; frequencies not clearly stated]. A boy started receiving prednisone at standard international doses at 21 months of age. One month later, prednisone was reduced to 40 mg on alternate days. At 26 months of age, he started ciclosporin, with prednisone 40 mg on alternate days. Three months later, prednisone was withdrawn. His side effects included Cushing syndrome. From 2 years and 7 months of age, he received mycophenolate mofetil 355–850 mg/m2/dose in two doses. Six months later, mycophenolate mofetil was switched to mycophenolic acid for 2 months due to episodes of vomiting and anorexia. After restarting mycophenolate mofetil 1 g/12h, he had no further incidents or relapses. A girl experienced her first NS attack at 2 years and 3 months of age, and started receiving prednisone at standard international doses. Over the next 15 months, she had further attacks while receiving prednisone on alternate days at 1 mg/kg to 45mg. From 4 years of age, she received mycophenolate mofetil 215–391 mg/m2/dose in two doses. Prednisone was maintained at 2.5 mg/week over the next year, then gradually tapered and discontinued at 7 years of age. Over the next 2 years, she developed isolated relapses, for which she received prednisone 15mg on alternate days. Mycophenolate mofetil was switched to mycophenolic acid for several months due to gastritis [duration of treatment to reaction onset not stated]. At last follow-up, she had restarted mycophenolate mofetil and was asymptomatic. She had not received prednisone for the past 10 months. However, she presented with weight gain, increased appetite, aggression, hypertrichosis and a Cushing syndrome appearance due to steroid therapy. A girl was treated with prednisone at international standard doses after her first NS attack at 3 years of age. After multiple attacks and a relapse while receiving prednisone 40 mg/m2 on alternate days, she received cyclophosphamide and prednisone 60 mg/m2/day for 3 months. Treatment was then stopped as she was asymptomatic for 1 year. From 4 years and 5 months of age, she required multiple courses of high-dose prednisone, as well as doses on alternate days of 0.32 mg/kg to 30mg. From 13 years and 4 months of age, she received mycophenolate mofetil, subsequently changed to mycophenolic acid as it was better tolerated. Steroid treatment was then stopped. At last follow-up, her steroid-induced side effects, including hypertrichosis, obesity, abdominal striae and Cushing syndrome appearance, had resolved. * one patient with no side effects to either prednisone or mycophenolate mofetil was also described Palanca Arias D,
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