Treatment of idiopathic XXXX by immunophillin modulation.

@entity3441 @entity1 @entity8 @entity137 @entity1987 @entity870 @entity628 @entity3450 @entity3446 @entity205 @entity134 @entity1140 @entity1011
Until 1985, glucocorticoids and cytotoxic drugs were the only treatments available for @entity3441 ( @entity3450 ), that is, @entity1987 ( @entity1987 ) and @entity628 ( @entity628 ). Trials of @entity205 (CsA) treatment of @entity3450 , the rationale of which was based on pathophysiologic considerations, have shown that this immunophillin modulator is effective in inducing and maintaining remission in @entity1 suffering from @entity3441 . It appears that the best results, in the order of 80% remission rate, are obtained in @entity134 -sensitive cases, essentially @entity1987 , and that in @entity134 -resistant @entity628 the drug obtains remission in no more than 20% of the cases. Addition of glucocorticoids increases the success rate to approximately 30% of cases. @entity8 is proportional to previous @entity8 , primary @entity8 ( @entity628 vs @entity1987 ) dosage >5.5 mg/kg/day and duration of treatment. The better bioavailability of the new formulation of @entity870 (Neoral), implies that the former dosage recommendations be reconsidered for distinctly lower figures. Repeat renal biopsy after 1 year of continuous CsA treatment is advisable, as stable serum @entity1011 levels may be falsely reassuring. CsA dependency is the rule during the first year of treatment. However, in some 25% of cases stable remission may be maintained after slow tapering off following 3-4 years of treatment. Other immunophillin modulators have been tried in the treatment of @entity3441 . Despite few preliminary reports indicating some success of @entity1140 the effects of this drug do not seem convincingly superior to CsA in terms of remission rate, @entity137 and dependency. @entity3446 has not been tried in the treatment of @entity3450 . Anecdotal cases of de novo @entity628 induced by @entity3446 in transplanted @entity1 might indicate that this drug is in fact contraindicated in the treatment of @entity3450 .
