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Iyengar A, Kamath N, Phadke KD, et al. Cyclosporine/ketoconazole reduces treatment costs for nephrotic syndrome. Indian J Nephrol. 2013;23(6):419-23doi: 10.4103/0971-4065.120338.
Iyengar, A., Kamath, N., Phadke, K. D., & Bitzan, M. (2013). Cyclosporine/ketoconazole reduces treatment costs for nephrotic syndrome. Indian journal of nephrology, 23(6), 419-23. https://doi.org/10.4103/0971-4065.120338
Iyengar, A, et al. "Cyclosporine/ketoconazole reduces treatment costs for nephrotic syndrome." Indian journal of nephrology vol. 23,6 (2013): 419-23. doi: https://doi.org/10.4103/0971-4065.120338
Iyengar A, Kamath N, Phadke KD, Bitzan M. Cyclosporine/ketoconazole reduces treatment costs for nephrotic syndrome. Indian J Nephrol. 2013 Nov;23(6):419-23. doi: 10.4103/0971-4065.120338. PMID: 24339519; PMCID: PMC3841509.
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Indian J Nephrol. 2013 Nov;23(6):419-23. doi: 10.4103/0971-4065.120338.

Cyclosporine/ketoconazole reduces treatment costs for nephrotic syndrome.

Indian journal of nephrology

A Iyengar, N Kamath, K D Phadke, M Bitzan

Affiliations

  1. Division of Pediatric Nephrology, St John's Medical College Hospital, Bangalore, India.

PMID: 24339519 PMCID: PMC3841509 DOI: 10.4103/0971-4065.120338

Abstract

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.

Keywords: Azoles; India; co-administration; cyclosporine; nephrotic syndrome; pediatric

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