Corticosteroid therapy for nephrotic syndrome in children

Steroid treatment for the first episode of childhood nephrotic syndrome: comparison of the 8 and 12 weeks regimen using an individual patient data meta-analysis

“…We hypothesize that the differences in clinical outcomes between the IPD meta-analysis and the trial of Webb et al may be a consequence of longer daily steroid treatment in the 12 weeks steroid regimen (6 weeks of daily steroids) compared to the 16 weeks steroid regimen (4 weeks of daily steroids). In accordance with our results on FRNS, the recently published Cochrane review of Hahn et al concluded little or no difference in the number with frequent relapses between the 2 and ≥ 3 months regimens based on studies at low risk of bias [13]. Post-hoc analyses of previous studies have suggested that an early age at onset is a risk marker for a complicated disease course [10,12].…”

“…As many aspects of nephrotic syndrome, such as underlying pathology [32], steroid responsiveness [33], and availability of second-line immunosuppressive agents seem to be changing over decades, the apparent difference in outcome may be based on the different era in which the Ehrich study was performed compared with the Teeninga and PREDNOS trials. As previously reported in the Cochrane review of Hahn et al [13], blinding was not mentioned in the Ehrich trial, which is a major limitation. Norero et al reported no superiority of the 12 weeks treatment in terms of mean relapse rate per patient in 18 months, number of patients with FRNS, adverse effects, and the number of patients with a relapse at 12 and 18 months of follow-up [14].…”

“…In contrast, Moundekhel et al concluded that the 12 weeks APN treatment was superior to the 8 weeks ISKDC in preventing relapses in nephrotic syndrome [15]. Of note, the trials of Norero et al, Paul et al, and Moundekhel et al were reported to have high or unclear risks on several bias items [13]. Importantly, the studies included in this IPD meta-analysis showed a low risk of bias on all bias items of the Cochrane review by Hahn et al [13].…”

“…This IPD meta-analysis was reported according to the Preferred Reporting Items for Systematic Review and Meta-Analyses of Individual Participant Data (PRISMA-IPD) statement [18]. We identified trials from the Cochrane reviews of Hahn et al [13,19]…”

“…Consequently, the 8 weeks International Study of Kidney Disease in Children (ISKDC) protocol and 12 weeks Arbeitsgemeinschaft für Pädiatrische Nephrologie (APN) protocol are among the most frequently used protocols in Europe [8]. Recently, a Cochrane review suggested little or no difference between the 8 and 12 weeks steroid regimens [13]. However, a direct comparison between these commonly used regimens has only been made in small cohorts and the results seem contradictory [14][15][16][17].…”