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 ORIGINAL ARTICLE
Year : 2013  |  Volume : 23  |  Issue : 6  |  Page : 419-423

Cyclosporine/ketoconazole reduces treatment costs for nephrotic syndrome


1 Division of Pediatric Nephrology, St John's Medical College Hospital, Bangalore, India
2 Department of Pediatrics, Division of Nephrology, McGill University, Montreal Children's Hospital, Montreal, Canada

Correspondence Address:
A Iyengar
Department of Pediatric Nephrology, St. John's Medical College Hospital, Bangalore - 560 034
India
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Source of Support: The study was supported by a research grant provided by the St. John's research society, St. John's Medical College, Bangalore., Conflict of Interest: None


DOI: 10.4103/0971-4065.120338

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Cyclosporine A (CyA) is an effective agent for the treatment of glucocorticoid-dependent idiopathic nephrotic syndrome (GCDNS), but costs are prohibitive in resource-poor societies. The objectives of this study were to evaluate the efficacy and safety of reducing the dose of CyA by co-administering ketoconazole. A prospective study targeting children 2-18 years of age with GCDNS in remission with CyA monotherapy was conducted. CyA dose was reduced by 50% and ketoconazole was added at 25% of the recommended therapeutic dose, and the drug levels and therapeutic and adverse effects (AE) were monitored. Continued combined therapy after completion of the 4-week trial period was offered. Ten patients (median age 9.5 years, range 3.0-16.0 years) were enrolled in the study. At week 4, the CyA dose was 2.2 ± 0.7 mg/kg/day compared with 5.6 ± 0.9 mg/kg/day at enrolment ( P < 0.0001). No AE were noted. All patients continued ketoconazole treatment for at least 3 months. CyA drug cost savings were 61%, and approximately 60% with ketoconazole cost included. The combination of an expensive immunosuppressive drug with a cheap metabolic inhibitor reduced the treatment costs by> 50% without increased adverse events or drug monitoring needs. This intervention demonstrates how access of patients with limited resources to needed drugs can be improved by interference with physiological drug elimination.






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