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Intermittent versus long-term tapering prednisolone for initial therapy in children with idiopathic nephrotic
N Ueda1, M Chihara, S Kawaguchi
1Department of Pediatrics, Fujita Gakuen Health University School of Medicine, Aichi, Japan.
Insights
A long-term tapering prednisolone regimen is safer and more effective for initial therapy in children with nephrotic syndrome than an intermittent regimen. This approach reduces relapses and steroid dependence, improving treatment outcomes.
Area of Science:
- Pediatric Nephrology
- Clinical Pharmacology
Background:
- Nephrotic syndrome is a common kidney disorder in children.
- Steroid-responsive nephrotic syndrome (SRNS) requires effective initial therapy to prevent complications.
- Current treatment guidelines explore various prednisolone regimens.
Purpose of the Study:
- To compare the efficacy and safety of two different initial prednisolone regimens in children with SRNS.
- To evaluate relapse rates, steroid responsiveness, and toxicity between regimens.
Main Methods:
- Forty-six children with SRNS were randomized into two groups.
- Group 1 received an intermittent prednisolone regimen.
- Group 2 received a long-term tapering prednisolone regimen.
Main Results:
- No significant differences were observed in relapse treatment, steroid responsiveness, or toxicity.
- Group 1 showed significantly higher rates of relapse within 6 months and frequent relapses/steroid dependence.
- P < 0.05 for both observed differences.
Conclusions:
- The long-term tapering regimen is safer and preferable for initial therapy in pediatric idiopathic nephrotic syndrome.
- This regimen effectively reduces relapse frequency and steroid dependence compared to intermittent therapy.
Abstract:
Forty-six children with steroid-responsive nephrotic syndrome were randomly allocated to receive two different prednisolone regimens for initial therapy. Twenty-nine children (group 1) received an intermittent regimen (60 mg/m2/day for 4 weeks, followed by 40/mg/m2/day on 3 days a week for 4 weeks); 17 children (group 2) had a long-term regimen (60 mg/m2/day for 4 weeks, followed by the same dose on alternate days for 4 weeks and the doses tapered by 10 mg/m2, given on alternate days every 4 weeks for 5 months). There was no difference between the two groups in the regimen used to treat relapses, steroid responsiveness, number of patients with relapses, and frequency of toxic reactions to steroids. However, the number of patients with a relapse within 6 months after initial therapy and the number of those with frequent relapses or steroid dependence were significantly higher in group 1 than in group 2 (P less than 0.05 for both). The data indicate that the long-term tapering regimen appears to be both safe and preferable to the intermittent regimen for initial therapy in children with idiopathic nephrotic syndrome.