Deflazacort Versus Prednisolone: Randomized Controlled Trial in Treatment of Children With Idiopathic Nephrotic Syndrome

Abstract

Background:Corticosteroids are the main therapy of nephrotic syndrome and goal of corticosteroid therapy is to obtain maximum clinical benefit with minimum adverse effects. Children are more vulnerable to side effects of corticosteroids related to growth and adrenal suppression, so a search for an alternative steroid with fewer side-effects is underway. Deflazacort is an oxazoline derivative and preliminary data suggest reduced osteoporosis, lesser growth retardation and weight gain with deflazacort. Objectives:This study was done to compare the effectiveness and safety of deflazacort in idiopathic nephrotic syndrome. Patients and Methods:Twenty five children with age between 2 to 12 years, with idiopathic nephrotic syndrome were enrolled. They were randomly assigned to receive deflazacort (Group A, n = 12) or prednisolone (Group B, n = 13) and were followed up for six months. Results:All children of group A and 11 of group B had remission. Two children from group B were steroid resistant. Mean time taken to induce remission was significantly (P = 0.012) less in group A (10.25 ± 2.41 days) than group B (12.55 ± 1.44 days). One patient in group A had relapse on follow up as compared to 3 in group B (P = 0.58). Statistically significant difference (P = 0.03) in change in mean height was found between group A (2.13 ± 0.50cm) and B (1.44 ± 0.45 cm), with group B gaining less height. Conclusions:Remission rate in both groups was comparable although time taken to induce remission was shorter in deflazacort group and there was a significant difference in change of mean height on follow up with prednisolone group gaining lesser height.

IPNA clinical practice recommendations for the diagnosis and management of children with steroid-sensitive nephrotic syndrome

“…Six milligrams of deflazacort have approximately the same anti-inflammatory potency as 5 mg of prednisolone or prednisone. There was no difference between deflazacort and PDN in the number achieving remission in the first episode of SSNS in two small RCTs [ 69 , 70 ]. However, fewer children relapsed following deflazacort treatment compared with PDN [ 69 , 71 ].…”

“…There was no difference between deflazacort and PDN in the number achieving remission in the first episode of SSNS in two small RCTs [ 69 , 70 ]. However, fewer children relapsed following deflazacort treatment compared with PDN [ 69 , 71 ]. There is a report of toxic epidermal necrolysis in two children with NS who received deflazacort [ 72 ].…”

Optimizing the corticosteroid dose in steroid-sensitive nephrotic syndrome

“…Deflazacort is derived from prednisolone and has similar glucocorticoid and mineralocorticoid properties. Small studies have shown it may be more effective in maintaining remission and may be associated with less corticosteroid toxicity [ 49 , 50 ]. However, the latest Cochrane meta-analysis shows no increased chance of remission with deflazacort, but concludes that it may reduce the number of relapses by 9–12 months.…”

Efficacy and Safety of Deflazacort in the Treatment Of Paediatric Nephrotic Syndrome

“…Deazacort, an oxazoline derivative is suggested to reduce osteoporosis, growth suppression and weight gain. (Singhal et al, 2015). In present study we explored the efcacy and safety of Deazacort in paediatric NS.…”