Efficacy and safety of tacrolimus combined with low-dose glucocorticoids vs. high-dose glucocorticoids in initial treatment of adult-onset minimal change disease: a retrospective cohort study

Background The treatment of adult minimal change disease (MCD) is challenging due to the side effects of high-dose and long-term glucocorticoid therapy as well as the frequent relapsing of the disease. Clinically, there is a demand for regimens that ensure rapid response and lower relapse rates, such as calcineurin inhibitors could fulfill this role. This study aims to compare the efficacy and safety of tacrolimus combined with low-dose glucocorticoids vs. high-dose glucocorticoids in the treatment of newly diagnosed adult MCD. Methods A retrospective cohort study was conducted on 59 adult patients diagnosed with MCD via renal biopsy at the Second Affiliated Hospital of Xi’an Jiaotong University, China. Patients were divided into two groups: the high-dose glucocorticoids group (GCs group, 39 patients, receiving 1 mg/kg/day prednisone) and the tacrolimus combined with low-dose glucocorticoid group (TAC group, 20 patients, receiving 0.05 mg/kg/day tacrolimus plus 10 mg/day prednisone). Both groups were followed for at least 24 weeks. The primary endpoint was the complete remission rate at 24 weeks, with secondary endpoints including relapse rates. And adverse events was analysed. Results At 24 weeks, the complete remission rates (90% vs . 100%, p = 0.111) and cumulative relapse rates (5% vs . 25.6%, p = 0.054) were comparable between the TAC and GCs groups. Patients receiving high-dose glucocorticoids were more likely to show incurred higher Cushingoid features (41% vs . 5%, p = 0.004). Patients in the tacrolimus group had a higher risk of transient serum creatinine elevation (10% vs . 0%, p = 0.045), resolving spontaneously. Longitudinal albumin recovery and estimated glomerular filtration rate (eGFR) stability were similar between groups. Conclusions Tacrolimus combined with low-dose glucocorticoids demonstrates comparable efficacy to high-dose glucocorticoids in inducing remission for adult-onset MCD, with a more favorable safety profile.