Lower prednisone dosing for steroid-sensitive nephrotic syndrome relapse: a prospective randomized pilot study
Yael Borovitz1, Hadas Alfandary1,2, Orly Haskin1
1Institute of Nephrology, Schneider Children's Medical Center of Israel, 4920235, Petach Tikva, Israel.
European Journal of Pediatrics
|November 16, 2019
Summary
Lower doses of prednisone (1-1.5 mg/kg/day) effectively treat childhood steroid-sensitive nephrotic syndrome relapses, significantly reducing cumulative steroid exposure compared to standard doses.
Area of Science:
- Pediatric Nephrology
- Clinical Pharmacology
Background:
- Steroid-sensitive nephrotic syndrome (SSNS) relapses traditionally require high-dose prednisone.
- Long-term corticosteroid use is associated with significant adverse effects.
Purpose of the Study:
- To prospectively evaluate the efficacy of reduced prednisone doses (1, 1.5, and 2 mg/kg/day) in treating SSNS relapses.
- To compare cumulative prednisone doses and time to remission across different treatment arms.
Main Methods:
- A prospective randomized pilot study involving 30 children with relapsed SSNS.
- Children were randomized to receive prednisone at 1, 1.5, or 2 mg/kg/day.
- Response was defined as 3 consecutive days without proteinuria.
Main Results:
- Lower cumulative prednisone doses were observed in the 1 mg/kg/day (24.9 ± 7.4 mg/kg) and 1.5 mg/kg/day (42.7 ± 25.9 mg/kg) groups compared to the 2 mg/kg/day group (45.5 ± 3.4 mg/kg).
- While time to remission varied, lower doses were generally effective, with only two patients requiring a switch to higher doses.
- The difference in time to response between the 1.5 and 2 mg/kg/day groups was statistically significant.
Conclusions:
- Treatment of childhood SSNS relapse with 1-1.5 mg/kg/day prednisone resulted in significantly lower cumulative steroid doses.
- Lower-dose prednisone appears to be a safe and effective alternative to standard dosing for SSNS relapses.
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