Comparison of Efficacy of Cyclophosphamide Versus Tacrolimus  in  Children With Steroid Dependent  and Frequent Relapsing Nephrotic Syndrome

Objectives: To compare the efficacy of Cyclophosphamide and Tacrolimus in the management of steroid dependent and frequent relapsing nephrotic syndrome in children. Study Design: Quasi Experimental Study. Place and Duration of Study: Department of Pediatric Nephrology, The Children's Hospital & The Institute of Child Health, Multan, from July 2020 to Dec 2020. Methodology: A total of 120 patients presenting with steroid dependent and frequent relapsing nephrotic syndrome that need 2nd line drug were divided in two groups. Group A included patients using Cyclophosphamide in a dose of 2.5mg/kg and group B used Tacrolimus in a dose of 0.1mg/kg. All patients were monitored and compliance of drugs were noted.Efficacy was calculated as proportions of patients achieving maintained remission of disease for six months duration. Results: Our study included n=80(66.7%) boys versus n = 40(33.3%) were girls having mean age 5.93±2.10 years (range 1 – 12 years). Mean weight was noted to be 17.1±3.84 kilograms. Majority 46cases (76.6%) in Tacrolimus–group achieved complete remission compared to 22cases (36.6%) in Cyclophosphamide-group, that results in usually exceedingly noteworthy p<0.005. Partial remission and drug resistance were 12cases (20%) and 2cases (3.33%) of Tacrolimus–group compared to 20cases (33.3%) and 18cases (30%) in Cyclophosphamide-group respectively. Sustained remission at 6months follow-up was 40cases (66.7%) in Tacrolimus–group compared to 16cases (26.6%) in Cyclophosphamide-group. Conclusion: Tacrolimus was more effective in inducing remission (76.6%) as compared to cyclophosphamide (36.6%) in steroid dependent and frequent relapsing Nephrotic syndrome.