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Use of levamisole in maintaining remission in steroid-sensitive nephrotic syndrome in children
U Dayal1, A K Dayal, J C Shastry
1Department of Child Health, Christian Medical College Hospital, Vellore, Tamil Nadu, India.
Insights
Levamisole therapy showed a trend towards longer remission maintenance in children with steroid-sensitive nephrotic syndrome. This effect was more pronounced in patients experiencing multiple relapses, suggesting potential benefits for this subgroup.
Area of Science:
- Pediatric Nephrology
- Immunomodulatory Therapy
Background:
- Steroid-sensitive nephrotic syndrome (SSNS) is a common kidney disorder in children.
- Corticosteroids are the primary treatment, but relapses are frequent.
- Maintaining remission is crucial to prevent long-term complications.
Purpose of the Study:
- To evaluate the efficacy of levamisole in maintaining remission in children with SSNS.
- To compare remission duration between children receiving levamisole and a control group.
Main Methods:
- A randomized controlled trial involving 61 children with SSNS in remission.
- Treatment group (33 patients) received levamisole (2-3 mg/kg/day) twice weekly for 12 months.
- Control group (28 patients) received no additional treatment.
Main Results:
- The levamisole group showed a trend towards longer remission maintenance (median 12 months vs. 10.5 months), though not statistically significant (p=0.10).
- In stratified analysis, multiple relapsers in the levamisole group had longer remission maintenance (p=0.08).
- 21/33 patients in the levamisole group remained in remission compared to 12/28 in the control group.
Conclusions:
- Levamisole therapy demonstrated a clinically significant trend towards improved remission maintenance in pediatric SSNS.
- The potential benefit was more evident in children with multiple relapses.
- Larger studies with extended follow-up are warranted to confirm these findings.
Abstract:
A randomized, controlled trial was conducted in a pediatric unit in a teaching hospital in India to assess the efficacy of levamisole in maintaining remission in children with steroid-sensitive nephrotic syndrome. Sixty-one children with steroid-sensitive nephrotic syndrome, who had achieved remission with corticosteroids, were allocated to a treatment group (33 patients) receiving levamisole (2-3 mg/kg/day) twice a week for 12 months or to a control group (28 patients) receiving no treatment. The main outcome measure was duration of remission. Thirty months later, in the levamisole group, 21 of 33 patients were in remission as against 12 of 28 patients in the control group (chi 2 = 2.54, p = 0.11, NS). The median duration of remission maintenance was 12 months in the levamisole group as compared with 10.5 months in the control group. On survival analysis, the difference in duration of remission maintenance between the two groups was not significant (p = 0.10), though there was a trend in favor of the treatment group. On stratified survival analysis, multiple relapsers in the levamisole group had longer remission maintenance than the control group though this did not reach statistical significance (p = 0.08). The clinically significant trend towards increased duration of remission maintenance in steroid-sensitive nephrotic syndrome observed with levamisole therapy, especially in patients with multiple relapses, may require a larger study with a longer follow-up for definitive confirmation.