Immunoregulation with Levamisole in Children with Frequently Relapsing Steroid Responsive Nephrotic Syndrome

Drachman, R.; Schlesinger, Menachem; Alon, Uri; Mor, J.; Etzioni, Amos; Shapira, Hava; Ohali, Melly; Drukker, Alfred

doi:10.1111/j.1651-2227.1988.tb10737.x

Cited by 17 publications

(7 citation statements)

References 20 publications

(6 reference statements)

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“…The immunomodulatory agent levamisole has been used as an adjunctive therapy in such patients [31,32,33,34,35,36,37,38] as a good alternative to major immunosuppressives [39]. This treatment leads to decreases in the number of relapses and the amount of prednisolone required.…”

Section: Discussionmentioning

confidence: 99%

Long-term effects of levamisole treatment in childhood nephrotic syndrome

et al. 2004

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The effects of levamisole treatment on long-term outcome were evaluated in a retrospective study of frequently-relapsing (FRNS, n=15), steroid-dependent (SDNS, n=13), and steroid-resistant (SRNS, n=6) nephrotic syndrome in 34 children (21 boys, 13 girls, mean age 5.0+/-3.4 years) during a 60-month follow-up period. The definition of frequent relapses was > or = 4 relapses per year. The current relapse was treated with prednisolone 60 mg/m2 per day for 4 weeks, then with 40 mg/m2 every other day for 4 weeks, after which the dose was tapered by 10 mg weekly. From the beginning of the 5th week, levamisole was introduced at a dose of 2 mg/kg per day. The duration of levamisole treatment was 17+/-7 months. Before starting levamisole treatment the mean level of proteinuria was 2.17+/-1.34 g/day and the relapse rate was 4.41/year. By the end of levamisole therapy, proteinuria had fallen to 0.142+/-0.211 g/day and the relapse rate to 0.41/year. No relapse occurred in 23 of the 34 patients during levamisole treatment. In the 24-month follow-up period after the discontinuation of levamisole, 28 children remained in total remission, while 6 had relapses. The cumulative steroid dose before levamisole therapy was 7,564.4+/-3,497.1 mg/year and following the introduction of levamisole 1,472.9+/-1,729.9 mg/year (P<0.0001). We observed reversible neutropenia in 5 patients, but no other side effects were seen. Our findings suggest that in FRNS and SDNS levamisole significantly reduces both the relapse rate and the cumulative steroid dose; therefore, it could be recommended for these patients. In SRNS patients it has also some benefit because proteinuria and the cumulative steroid dose could be reduced significantly.

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Section: Discussionmentioning

confidence: 99%

Long-term effects of levamisole treatment in childhood nephrotic syndrome

et al. 2004

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“…It is a randomized controlled clinical trial, using Ievamisole as the sole drug in the treatment group, keeping in mind the following facts, viz (a) initial remission is easily induced with corticosteroids with minimal side-effects [15], (b) relapses occurring in the first 6 months after attaining remission very often herald multiple subsequent relapses [17], (c) relapses are directly related to depression of T-cell function [7], (d) Ievamisole is known to restore T-cell function [10], (e) the responses obtained in most studies with Ievamisole were directed at inducing remission and not at maintaining remission [9,11], and (0 most studies recruited only multiple relapsers [11][12][13].…”

Section: Discussionmentioning

confidence: 99%

Use of Levamisole in Maintaining Remission in Steroid-Sensitive Nephrotic Syndrome in Children

Dayal

Shastry

et al. 1994

Nephron

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A randomized, controlled trial was conducted in a pediatric unit in a teaching hospital in India to assess the efficacy of levamisole in maintaining remission in children with steroid-sensitive nephrotic syndrome. Sixty-one children with steroid-sensitive nephrotic syndrome, who had achieved remission with corticosteroids, were allocated to a treatment group (33 patients) receiving levamisole (2-3 mg/kg/day) twice a week for 12 months or to a control group (28 patients) receiving no treatment. The main outcome measure was duration of remission. Thirty months later, in the levamisole group, 21 of 33 patients were in remission as against 12 of 28 patients in the control group (χ² = 2.54, p = 0.11, NS). The median duration of remission maintenance was 12 months in the levamisole group as compared with 10.5 months in the control group. On survival analysis, the difference in duration of remission maintenance between the two groups was not significant (p = 0.10), though there was a trend in favor of the treatment group. On stratified survival analysis, multiple relapsers in the levamisole group had longer remission maintenance than the control group though this did not reach statistical significance (p = 0.08). The clinically significant trend towards increased duration of remission maintenance in steroid-sensitive nephrotic syndrome observed with levamisole therapy, especially in patients with multiple relapses, may require a larger study with a longer follow-up for definitive confirmation.

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“…Since the first publication of Tanphaichitr et al [6], several studies have suggested that levamisole reduces the frequency of relapses and diminishes steroid doses in steroid-dependent patients [7,8,9,10,11,12,13,14,15,16,17,18,19]. The majority of studies found levamisole to be free from serious side effects on a long-term basis.…”

Section: Introductionmentioning

confidence: 95%

Experience with levamisole in frequently relapsing, steroid-dependent nephrotic syndrome

et al. 2005

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This was a controlled prospective study on the use of an immunomodulator drug, levamisole, in the treatment of frequently relapsing, steroid-dependent (FR/SD) idiopathic nephrotic syndrome. The study was started on 1 January 2001 and completed on 31 December 2003. There were two groups: a treatment group who received levamisole (2.5 mg/kg) on alternate days for 1 year and a control group who received low-dose prednisolone only (<0.5 mg/kg) on alternate days for 1 year. There were a total of 56 patients (32 in the treatment group and 24 in the control group). The male to female ratio was 1.66:1 in both groups. The mean age upon initial diagnosis was 3.3 years in the levamisole group versus 4.3 years in the control group. The mean duration from diagnosis to the start of the second line treatment was 3.2 years in the levamisole group versus 2.8 years in the control group. The relapse rate and the total cumulative dose of prednisolone during the year prior to second line therapy was compared to that during the year following the institution of second line therapy in 56 patients. The mean relapse rate was reduced more significantly in the levamisole group. It was reduced by 0.29 versus 0.11 relapses/patient/month in the control group (P =0.0001). The mean cumulative dose of steroids was also reduced more significantly in the levamisole group. It was reduced by 293 versus 102 mg/m(2)/month in the control group (P <0.0001). Therapy failure was seen in 3/32 (9.4%) in the levamisole group versus 12/24 (50%) in the control group. Of the patients, 20/32 (62.5%) using levamisole were relapse-free in the follow-up year post therapy, while no patient was relapse-free in the control group over the same period. No major adverse effects of levamisole were seen. The cost of levamisole therapy was estimated to be US$ 25 per year for a 20-kg body weight child. Thus, we concluded that levamisole is a highly efficacious, safe and easily affordable initial therapy for FR/SD idiopathic nephrotic syndrome.

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Immunoregulation with Levamisole in Children with Frequently Relapsing Steroid Responsive Nephrotic Syndrome

Cited by 17 publications

References 20 publications

Long-term effects of levamisole treatment in childhood nephrotic syndrome

Long-term effects of levamisole treatment in childhood nephrotic syndrome

Use of Levamisole in Maintaining Remission in Steroid-Sensitive Nephrotic Syndrome in Children

Experience with levamisole in frequently relapsing, steroid-dependent nephrotic syndrome

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