Long-term efficacy and safety of common steroid-sparing agents in idiopathic nephrotic children

Abstract

Although there are serious safety concerns regarding tacrolimus, it is more effective than MMF or levamisole in maintaining relapse-free survival. However, unlike MMF, the relative efficacy of tacrolimus in preventing further relapses is seen only when the patient is on the drug. Taking together the long-term efficacy and safety data observed, MMF appears as a safe and effective alternative to tacrolimus in managing pediatric FRNS/SDNS.

Levamisole therapy in children with frequently relapsing and steroid-dependent nephrotic syndrome: a single-center experience

“…Side effects were not rare, though they were mild in nature and fully reversible after withdrawal of the medication. Incidence of side effects of levamisole treatment in children with INS varies from no adverse events [4, 20, 23] to 14.7% [26]. Like in our patients, most cases of adverse events do not pose a serious risk for a patient.…”

“…Also, in a recently published retrospective study by Basu et al . tacrolimus was significantly more effective than mofetil mycophenolate or levamisole in maintaining relapse-free survival over a period of 30 months in a cohort of 340 children with FRNS/SDNS [23]. Nevertheless, taking into account its low cost and good safety profile, we believe that in the era of modern immunosuppressive medications such as mofetil mycophenolate, tacrolimus, and rituximab there is still a place for levamisole application in children with INS.…”

Mycophenolate mofetil in paediatric autoimmune or immune‐mediated diseases of the central nervous system: clinical experience and recommendations

“…Although studies specifically designed to evaluate MMF safety in paediatric neurology are not available, our patients and other children treated with MMF both in neurological 18 and in other paediatric conditions 5,6,39 seem to support a favourable safety profile. In recent studies on adult NMOSD, MMF had significantly better tolerability than azathioprine.…”

“…2 MMF is also largely used as a steroid-sparing agent for chronic immunosuppression in rheumatology and in neurological autoimmune and immune-mediated conditions, with data suggesting a relatively safe profile. [3][4][5][6] MMF has been used for nearly two decades in myasthenia gravis, 7,8 although its role is less clear in chronic inflammatory demyelinating polyradiculoneuropathy. 9 In central nervous system (CNS) autoimmune and immune-mediated conditions, MMF has been increasingly used in relapsing demyelinating diseases such as neuromyelitis optica spectrum disorders (NMOSD) 4,10-14 and myelin oligodendrocyte glycoprotein (MOG)-associated disease.…”

A novel immunomodulatory treatment involving mycophenolate mofetil and corticosteroids for pediatric autoimmune cytopenias

“…Given the gastrointestinal histologic changes caused by MMF use, as well as case reports in the literature, it can be hypothesized that severe colitis and enteropathy may be long‐term effects from prolonged MMF use . Data on long‐term effects in the pediatric population are even more limited, but one recent study on MMF used to treat pediatric patients with idiopathic nephrotic syndrome only reported minor side effects after 30 months of MMF treatment …”