Long-term results of two unconventional agents in steroid-dependent nephrotic children.
Children with steroid-dependent minimal change nephrotic syndrome are prone to serious steroid side effects. Alternative therapies, such as oral cyclophosphamide, may also have serious side effects. We conducted this novel prospective study to compare the long-term efficacies of levamisole and I.V. pulse cyclophosphamide as therapies with potentially fewer side effects. This study included 40 children with idiopathic steroid-dependent minimal change nephrotic syndrome (age 3-15 years; 31 boys and 9 girls). The patients were randomized into two equal groups. One group received levamisole 2.5 mg/kg on alternate days (levamisole group) while the other group received I.V. cyclophosphamide 500 mg/m2/month for six months (cyclophosphamide group). Prednisolone was gradually withdrawn. After stopping treatment, the number of patients that maintained remission was five (25%) in each group at six months, four (20%) versus two (10%) at one year and three (15%) versus one (5%) at two years in the levamisole and cyclophosphamide groups respectively, and one (5%) in each group at three and four years. The overall side effects were mild and both drugs were well tolerated. In view of the results, we recommend trial of levamisole before adopting other therapies with more serious side effects in such patients.
Donia
Ahmed Farouk
AF
Nephrology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt. afdonia@hotmail.com
Ammar
Hesham Mohamed
HM
El-Agroudy
Amgad El-Baz
Ael-B
Moustafa
Fatma El-Husseini
Fel-H
Sobh
Mohamed Abdel-Kader
MA
D002648:Child; D003520:Cyclophosphamide / Q000009:adverse effects / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D007275:Injections, Intravenous; D007978:Levamisole / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D009402:Nephrosis, Lipoid / Q000188:drug therapy*; D009404:Nephrotic Syndrome / Q000188:drug therapy*; D011239:Prednisolone / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D020551:Pulse Therapy, Drug; D012074:Remission Induction; D019233:Retreatment; D013997:Time Factors; D016896:Treatment Outcome
D005938:Glucocorticoids; D007978:Levamisole; D003520:Cyclophosphamide; D011239:Prednisolone