Clinical Response to Levamisole Versus Low Dose Prednisolone in Frequently Relapsing Steroid Sensitive Nephrotic Syndrome
Rezoana Rima1, Mohammad Hanif2
Background: Levamisole is an immunomodulating drug has shown high response
rate, reducing relapse rate and significant steroid sparing effects in frequent relapse
nephrotic syndrome (FRNS).
Objective: To evaluate the effectiveness of levamisole versus low dose prednisolone
in maintain remission in children with steroid sensitive nephrotic syndrome (SSNS)
who had a frequent relapsing and/or steroid dependent course.
Methodology: This prospective randomized controlled trial was conducted during
the period from July 2003 to August 2005. Children in relapse were randomly assigned
to either the levamisole group or low dose prednisolone group. A total of 40 patients
were enrolled. Remission was firstly induced by steroid then levamisole was added
and steroids were completely withdrawn within 3 months. Low dose prednisolone
(LDP) group was also induced remission with standard dose prednisolone. In both
groups treatment was continued for 1 year.
Results: Median age was 6 years (2-13 years), 29 were male and 11 were female.
Mean number of relapse/patient/year was reduced from 4.40±0.75 to 0.75±0.20 in
levamisole group (p<0.001) and from 4.40±0.82 to 1.70±0.98 in LDP group (p<0.001).
Eight months after stopping treatment mean number of relapse is significantly less
in levamisole group than LDP group (0.90±0.55 and 1.40±0.60 respectively, p< 0.05).
No significant side effects were reported in any group.
Conclusion: Levamisole is more effective in reducing relapse rate than low dose
prednisolone. It is safe and less costly than low dose prednisolone.
Key word: Nephrotic syndrome, frequent relapse, levamisole, low dose prednisolone.