Long versus standard prednisone therapy for initial treatment of idiopathic nephrotic syndrome in children

Abstract

Two regimens of steroid treatment for the initial attack of idiopathic nephrotic syndrome (NS) in children were compared in a controlled prospective multi-centre study. Long prednisone therapy consisted of 60 mg/m2 per 24 h for 6 weeks, followed by alternate day 40 mg/m2 per 48 h for 6 weeks. The standard prednisone therapy was 60 mg/m2 per 24 h for 4 weeks, followed by 40 mg/m2 per 48 h for 4 weeks. A total of 71 children with an initial attack of idiopathic NS were allocated at random to the two groups. The cumulative rate of patients with sustained remissions after 2 years was significantly higher after the long course than after the standard treatment (49% vs 19%, P = 0.0079). The mean relapse rate per patient at intervals of 3, 6 and 12 months was lower in the long-course prednisone group than in the standard prednisone group, and the proportion of children with frequent relapses during any subsequent 6 months period was lower in the long-course group than in the standard group (29% vs 57%, P = 0.03). Mild side-effects of corticosteroid therapy were observed more frequently after long-course prednisone treatment. It is concluded that long-course prednisone therapy of the initial attack of steroid responsive NS is preferable to the standard regimen because it reduces the rate of subsequent relapses without increasing the risk for severe steroidal side-effects.

Cyclosporin A is superior to cyclophosphamide in children with steroid-resistant nephrotic syndrome—a randomized controlled multicentre trial by the Arbeitsgemeinschaft für Pädiatrische Nephrologie

“…All patients had to be treated according APN treatment protocol [23] or the International Study of Kidney Disease in Children (ISKDC) therapy scheme [24] and had to receive at least 4 weeks of daily PRD without reaching complete remission. Minimal change nephropathy, FSGS or diffuse mesangial proliferation (MP) was verified by kidney biopsy.…”

“…Prior to enrolment parental informed consent and, where applicable, patient's assent was obtained. Patients with hereditary, syndromic or secondary SRNS were excluded as were patients who had received pre-treatment with immunosuppressive drugs other than PRD and prednisolone and not according APN [23] or ISKDC treatment protocol [24].…”

“…This is to be followed by 40 mg/m 2 BSA over a 48-h period as a single dose in the morning (maximum 60 mg/day) for another 6 weeks [23].…”

Editorials

“…Five decades ago, the ISKDC empirically recommended 8 weeks of prednisone treatment for the initial episode of nephrotic syndrome; this increased to 12 weeks based on a randomized study by the APN [12]. Over the next 25 years, multiple openlabel randomized studies (some with significant bias) showed that further prolongation of therapy was even better, resulting in meta-analysis based guidelines for ~7-month initial therapy, despite risks of steroid toxicity [13].…”

Corticosteroids for the initial episode of steroid-sensitive nephrotic syndrome

“…The studies included in the systematic review published in 2000 [3] and in the updates to 2007 [4] were generally of high or unclear risk of bias. Only three studies showed adequate allocation concealment [12][13][14], and no studies were blinded. In contrast, three [5][6][7] of the four studies added to the 2015 update demonstrated adequate allocation concealment, and two studies were blinded [5,7].…”