title: Efficacy of higher-dose levamisole in maintaining remission in steroid-dependant nephrotic syndrome.
abstract: OBJECTIVE
  Levamisole (LEV) has been used successfully on an alternate-day regime of 2.5 mg/kg in steroid-dependant nephrotic syndrome (SDNS) to maintain remission. This pilot study was carried out between 2010 and 2015 at a single center in Sri Lanka to evaluate the efficacy of LEV prescribed at 2.5 mg/kg daily, which is double the alternate-day dose.
  
  
  METHODS
  Sequential children with SDNS, relapsing more than twice in the preceding 12 months and previously treated with LEV and low-dose alternate-day prednisolone (0.1-0.6 mg/kg) were recruited to the study. This group received LEV (2.5 mg/kg) daily with the same dose of alternate-day prednisolone for 1 year. Urine protein excretion was recorded by parents on a daily basis, and the presence of 3+ proteinuria on 3 consecutive days was considered a relapse. Full blood counts and liver function tests were performed every 3 months to monitor for adverse effects.
  
  
  RESULTS
  Sixty-four children were enrolled into the study; six were excluded due to prescription of other immunosuppressive drugs. Median age was 7.9 years; 33 were boys. The number of relapse episodes was 163 [mean per patient 2.8 ± standard deviation (SD) 0.8] in patients on alternate-day LEV and 77 (mean 1.3 ± SD 0.9) for those on daily LEV during the 12-month period of observation. The P value 0.000 (according to the Wilcoxon signed-rank test) was <0.001. No major adverse events were noted.
  
  
  CONCLUSIONS
  The prescription of daily LEV is effective and safe for maintaining SDNS remission.
authors.affiliation: Department of Paediatrics, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka. asiriabey26@gmail.com.
authors.forename: Asiri S
authors.initials: AS
authors.lastname: Abeyagunawardena
authors.affiliation: Department of Paediatrics, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
authors.forename: Umeshi
authors.initials: U
authors.lastname: Karunadasa
authors.affiliation: Department of Paediatrics, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
authors.forename: Heshan
authors.initials: H
authors.lastname: Jayaweera
authors.affiliation: Department of Paediatrics, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
authors.forename: Shenal
authors.initials: S
authors.lastname: Thalgahagoda
authors.affiliation: Department of Community Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
authors.forename: Sampath
authors.initials: S
authors.lastname: Tennakoon
authors.affiliation: Outpatient Department, Teaching Hospital Peradeniya, Peradeniya, Sri Lanka.
authors.forename: Shamali
authors.initials: S
authors.lastname: Abeyagunawardena
mesh_terms: D000276:Adjuvants, Immunologic / Q000494:pharmacology / Q000627:therapeutic use*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007668:Kidney / Q000503:physiopathology; D007978:Levamisole / Q000494:pharmacology / Q000627:therapeutic use*; D008111:Liver Function Tests; D008297:Male; D009404:Nephrotic Syndrome / Q000188:drug therapy* / Q000652:urine; D009503:Neutropenia / Q000097:blood / Q000139:chemically induced; D009504:Neutrophils / Q000187:drug effects; D010865:Pilot Projects; D011239:Prednisolone / Q000627:therapeutic use; D011507:Proteinuria / Q000188:drug therapy* / Q000652:urine; D012008:Recurrence; D065667:Renal Elimination; D013188:Sri Lanka; D016896:Treatment Outcome
chemical_list: D000276:Adjuvants, Immunologic; D007166:Immunosuppressive Agents; D007978:Levamisole; D011239:Prednisolone
keywords: Low-dose levamisole; Relapse; Steroid-dependant nephrotic syndrome