If the patient responds to steroids but develops steroid toxicity or steroid dependence what other treatment options are there for MCD?
Several treatment options are available for the child or adult with steroid toxicity or steroid dependence, each with its own unique risk-benefit profile.
The goal of therapy for these patients is to avoid the complications of nephrotic syndrome by maintaining remission while minimizing the toxicities of therapy.
The first therapy used for these patients is alternate-day prednisone therapy, tapered slowly to the lowest dose that will maintain a remission.
If that fails, other options include 12-week courses of oral cyclophosphamide (or chlorambucil), longer courses (1 to 2 years) of cyclosporine, mycophenolate mofetil, azathioprine, tacrolimus, or levamisole.
These medications should only be prescribed by physicians who are familiar with their toxicities.
