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Corticosteroid therapy in nephrotic syndrome: a meta-analysis of randomised controlled trials
E M Hodson1, J F Knight, N S Willis
1Centre for Kidney Research, Royal Alexandra Hospital for Children, PO Box 3515, Parramatta, Sydney, NSW 2124, Australia. Elisah@nch.edu.au
Insights
Longer corticosteroid treatment for nephrotic syndrome reduces relapse risk. Prednisone for at least three months, ideally up to seven, is recommended for children to prevent future episodes without increased adverse events.
Area of Science:
- Pediatric Nephrology
- Clinical Pharmacology
- Evidence-Based Medicine
Background:
- Steroid-responsive nephrotic syndrome (SRNS) frequently relapses in children.
- Optimizing corticosteroid therapy is crucial for managing SRNS and preventing relapses.
Purpose of the Study:
- To evaluate the efficacy and safety of varying corticosteroid regimens for preventing relapse in pediatric SRNS.
- To determine the optimal duration of prednisone treatment for initial episodes of SRNS.
Main Methods:
- Meta-analysis of 12 randomized controlled trials involving 868 children (3 months to 18 years).
- Primary outcome measure was the frequency of relapse.
- Analysis focused on comparing different durations of prednisone therapy.
Main Results:
- Longer prednisone treatment (≥3 months vs. 2 months) significantly reduced relapse risk at 12-24 months (RR 0.73; 95% CI 0.60-0.89).
- An inverse linear relationship was observed between treatment duration and relapse risk (p=0.05).
- No increase in adverse events was associated with longer treatment durations.
Conclusions:
- Children experiencing their first episode of SRNS benefit from prednisone treatment for at least three months.
- Treatment durations up to seven months demonstrated increased benefit in preventing relapses.
- Extended corticosteroid therapy is a safe and effective strategy for SRNS relapse prevention.
Aims:
To determine the benefits and toxicity of different corticosteroid regimes in preventing relapse in steroid responsive nephrotic syndrome.
Design:
Meta-analysis of randomised controlled trials.
Subjects:
Twelve trials involving 868 children aged 3 months to 18 years.
Main Outcome Measure:
Frequency of relapse.
Results:
A meta-analysis of five trials, which compared two months of prednisone with three months or more in the first episode, showed that the longer duration significantly reduced the risk of relapse at 12-24 months (relative risk 0.73; 95% confidence interval 0.60 to 0.89) without an increase in adverse events. There was an inverse linear relation (relative risk 1.382 (SE 0.215) - 0.133 (SE 0.048) duration; r(2) = 0.66; p = 0.05) between the duration of treatment and risk of relapse.
Conclusions:
Children in their first episode of steroid responsive nephrotic syndrome should be treated with prednisone for at least three months, with an increase in benefit being shown for up to seven months of treatment.