Combined Therapy Of Tacrolimus And Low-dose Prednisone In Nephrotic Syndrome And Concomitant HBsAg Positive

Objective:To assess the safety and efficacy of tacrolimus (TAC) combined with low dose of prednisone in nephrotic syndrome and concomitant HBsAg positive (NS-HBsAg).Methods:Forty patients with NS-HBsAg with minimal change disease (MCD) or slight mesangialproliferative glomerulonephritis (SMsPGN) were included in the cohort study. TAC group (n=20) receiving TAC and low-dose prednisone (0.5mg/kg/d), prednisone group (n=20) receiving standard prednisone regimen (1mg/kg/d). The initial dose of TAC was0.05mg/kg/d, divided to2daily dose, and the dose was adjusted according to the blood through level. The drug concentration maintained5-10ng/ml. The dose of prednisone tapered gradually to be discontinued. The duration of follow-up was12months. Both the two group received lamivudine for antiviral therapy. The treatment effects, HBV recurrence and side effects were observed in2groups.Results:40patients met criteria for enrollment, and39patients completed therapy. One patient quit because of femoral head necrosis. At the end of6months, complete remission (CR) and partial remission (PR) was observed in19patients (95%) and1patient (5%) in TAC group, while in prednisone group, CR and PR were seen in16patients (80%) and3patients(15%). In both group, the proteinuria was significantly decreased and the level of serum albumin was significantly increased after treatment. After anti-viral therapy with lamivudine, the titer of HBV-DNA was negative in8patients (8/10,80%), with no case of HBV activation. The occurence of HBV activation was observed in2patients in prednisone group.Conclusions:The results demonstrated that combined regimen of TAC and low-dose prednisone is as effective as the conventional prednisone therapy in NS-HBsAg. The TAC protocol seems to be superior with regard to HBV reactivation compared with prednisone therapy.