Levamisole for corticosteroid-dependent nephrotic syndrome in childhood. British Association for Paediatric...

Area of Science:

• Pediatric Nephrology
• Immunology
• Pharmacology

Background:

• Children with nephrotic syndrome often require high-dose corticosteroids, leading to dependence and potential long-term toxicity.
• Conventional alkylating therapies may fail to maintain remission and carry significant risks with prolonged use.

Purpose of the Study:

• To evaluate the efficacy and safety of levamisole as an alternative immunostimulant for maintaining steroid-free remission in children with frequently relapsing nephrotic syndrome.

Main Methods:

• A randomized controlled trial involving 61 children with corticosteroid-dependent nephrotic syndrome.
• Patients received either levamisole (2.5 mg/kg on alternate days) or a placebo for up to 112 days, with a planned reduction and cessation of prednisolone by day 56.

Main Results:

• Significantly more patients in the levamisole group (14/31) remained in remission at 112 days compared to the placebo group (4/30) (p < 0.01).
• No significant adverse events were reported in either group.

Conclusions:

• Levamisole is an effective and safe option for maintaining steroid-free remission in children with frequently relapsing nephrotic syndrome.
• It presents a promising alternative to prolonged immunosuppression or less effective therapies.