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Should we stop dosing steroids per body surface area for nephrotics?
Guido Filler1,2,3, Lisa A Robinson4,5,6,7
1Department of Pediatrics, Schulich School of Medicine & Dentistry, Western University, 800 Commissioners Road East, London, ON, Canada, N6A 5 W9. guido.filler@lhsc.on.ca.
Pediatric Nephrology (Berlin, Germany)
|December 30, 2015
Summary
Prednisolone dosing for childhood nephrotic syndrome showed no difference in remission or relapse rates between weight-based and body surface area-based methods. Further research is needed to optimize pediatric steroid therapy.
Area of Science:
- Pediatric Nephrology
- Clinical Trials
- Pharmacology
Background:
- Idiopathic nephrotic syndrome is a common kidney disease in children.
- Prednisolone is a standard treatment, but optimal dosing strategies are debated.
- This study compared body weight-based vs. body surface area-based prednisolone dosing in 100 children.
Discussion:
- The study's inclusion of relapsing patients and short 6-month follow-up limit generalizability.
- Lack of age-based subgroup analysis and correlation between steroid dose and exposure are noted limitations.
- The editorial emphasizes the need to consider age-dependent drug disposition (ontogeny) in pediatric dosing.
Key Insights:
- No significant difference in time to remission or relapse rates was observed between the two dosing methods.
- Kaplan-Meier analysis was used to compare remission times.
- The study highlights potential areas for improvement in pediatric clinical trial design and reporting.
Outlook:
- Future trials should incorporate stricter inclusion criteria and longer follow-up periods.
- Investigating the ontogeny of drug disposition is crucial for personalized pediatric steroid therapy.
- Adherence to CONSORT criteria is essential for transparent and reliable reporting of randomized controlled trials.
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