A controlled study of deflazacort in the treatment of idiopathic nephrotic syndrome

Abstract

Forty patients with steroid-dependent idiopathic nephrotic syndrome (INS), a mean follow-up of 5.5 years, and a mean number of relapses of ten were blindly assigned to either deflazacort (DFZ) (n = 20) or prednisone (PDN) (n = 20) according to a ratio of equivalence of DFZ/ PDN = 0.8. This treatment was given for 1 year. The number of relapses was significantly lower in patients receiving DFZ. After 1 year, 12 remained in remission with DFZ compared with 2 with PDN. Growth velocity was not different in the two groups. Bone mineral content, assessed by quantitative computed tomography of L1 L2 vertebrae, decreased after 1 year by 6% in the DFZ group versus 12% in the PDN group (NS). The mean body weight increase of +3.9 +/- 4.1 kg in the PDN group was higher than that of the DFZ group, +1.7 +/- 2.8 kg (P = 0.06). Cushingoid symptoms tended to be less after 12 months in the DFZ group. In conclusion, this study shows that DFZ was more effective than PDN in limiting relapses in steroid-dependent INS, and that cushingoid symptoms, weight gain, and decrease in bone mineral content tended to be less marked with this drug than with PDN.

Evidence-based management of steroid-sensitive nephrotic syndrome

“…Deflazacort [14,15,24] significantly reduced the number of children with steroid-dependent SSNS who relapsed during therapy (40 children; RR 0.44; 95% CI 0.25-0.78), without significant differences in side effects.…”

Corticosteroid therapy in nephrotic syndrome: a meta-analysis of randomised controlled trials

“…Only three studies were analysed on an intention to treat basis 2226 28 Fewer than 10% of participants were excluded in seven studies 19-2426Only one study28 reported that outcome assessment was blinded.…”

“…26 28 Fewer than 10% of participants were excluded in seven studies 19-2426Only one study28 reported that outcome assessment was blinded. However, most studies reported the primary outcome measure using the ISKDC's definition of relapse 5…”

Experience with deflazacort in children and adolescents after renal transplantation

“…Their adverse effects on body growth, body composition, bone mineralization, and other organ functions restrict the application in grafted children and adolescents. Attempts to replace conventional glucocorticoids by deflazacort (DFZ), a methyloxazoline derivative of prednisone [1], have suggested that this agent exerts a similar anti-inflammatory and immunosuppressive action in various clinical conditions, associated with fewer side effects on bone mineralization, growth, blood pressure (BP), and metabolism [2,3,4,5,6,7]. There are only a few studies of the application of DFZ for immunosuppression after TX in adults [8,9,10] and children [11,12], and most are restricted to short observation periods.…”