Prolonged versus standard prednisolone therapy for initial episode of idiopathic nephrotic syndrome

Mishra, Om P.; Thakur, Neha; Mishra, Rahul; Prasad, Rajniti

doi:10.5301/jn.5000016

Cited by 13 publications

(15 citation statements)

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“…The majority of paediatric patients are steroid sensitive but approximately 20% of children develop steroid resistance . In patients with steroid‐dependent nephrotic syndrome (SDNS) or/and steroid‐resistant nephrotic syndrome (SRNS), immunosuppressive therapy with cyclophosphamide, mycophenolate mofetil or calcineurin inhibitors is used in order to induce or sustain remission . However, due to the many potential adverse events or/and the lack of satisfactory results, the search for alternative ways of the treatment, like monoclonal antibodies, continues .…”

Section: Introductionmentioning

confidence: 99%

Multicenter analysis of the efficacy and safety of a non‐standard immunosuppressive therapy with rituximab in children with steroid‐resistant nephrotic syndrome

Zachwieja

Silska-Dittmar

Zurowska

et al. 2018

Clin Exp Pharma Physio

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The aim of the study was a multicenter analysis of the efficacy and safety of a nonstandard immunosuppressive therapy with rituximab (Rtx) in children with steroidresistant nephrotic syndrome (SRNS) with particular emphasis on the possibility of permanent discontinuation or dose reduction of other immunosuppressive drugs such as glucocorticoids and cyclosporine A after 6 months of observation. The study group consisted of 30 children with idiopathic nephrotic syndrome, who were unresponsive to standard immunosuppressive treatment, and hospitalized in the years 2010-2017 in eight paediatric nephrology centres in Poland. The children were administered a single initial infusion of rituximab at the dose of 375 mg/m 2 of the body surface area. Proteinuria, the daily supply of glucocorticoids, and cyclosporine were assessed at the moment of the start of the treatment and after 6 months since its commencement. Before Rtx therapy, complete remission was found in 13 patients (43%) and partial remission was found in 8 patients (26%). These numbers increased to 16 (53%) and 12 (40%), respectively. At the start of the treatment 23 patients (76.6%) were treated with cyclosporine A. After 6 months, this number decreased to 15 patients (35%). At the start of the treatment, 18 patients (60%) were treated with prednisone. After 6 months, this number decreased to 8 patients (44%). Children with SRNS may potentially benefit from Rtx treatment despite relative risk of side effects. The benefits may include reduction of proteinuria or reduction of other immunosuppressants. K E Y W O R D Scyclosporine A, glomerulonephritis, glucocorticoids, nephrology, paediatrics

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Section: Introductionmentioning

confidence: 99%

Multicenter analysis of the efficacy and safety of a non‐standard immunosuppressive therapy with rituximab in children with steroid‐resistant nephrotic syndrome

Zachwieja

Silska-Dittmar

Zurowska

et al. 2018

Clin Exp Pharma Physio

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“…To review our results in the context of other reports, we searched for studies comparing 3-with (approximately) 6-months prednisolone use for the initial episode of NS. Four studies had been reported in the work by Hodson et al 7 We found one additional study by Mishra et al 13 Characteristics of the five previous studies revealed several limitations (Supplemental Table 4). None of the studies included a placebo or blinding in their design [12][13][14][15][16] ; allocation concealment was inadequate or not reported in three studies.…”

Section: Discussionmentioning

confidence: 84%

“…Four studies had been reported in the work by Hodson et al 7 We found one additional study by Mishra et al 13 Characteristics of the five previous studies revealed several limitations (Supplemental Table 4). None of the studies included a placebo or blinding in their design [12][13][14][15][16] ; allocation concealment was inadequate or not reported in three studies. 13,14,16 In at least one study, patients who did not complete study medication were excluded from the analysis after randomization.…”

Section: Discussionmentioning

confidence: 84%

“…13,14,16 In at least one study, patients who did not complete study medication were excluded from the analysis after randomization. 13 Interestingly, two studies were never fully published. Before our study, the Japanese trial by Hiraoka et al 12 was the only published study reporting adequate concealment of allocation.…”

Section: Discussionmentioning

confidence: 99%

“…None of the studies included a placebo or blinding in their design [12][13][14][15][16] ; allocation concealment was inadequate or not reported in three studies. 13,14,16 In at least one study, patients who did not complete study medication were excluded from the analysis after randomization. 13 Interestingly, two studies were never fully published.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Extending Prednisolone Treatment Does Not Reduce Relapses in Childhood Nephrotic Syndrome

Teeninga

Holthe

Rijswijk

et al. 2013

Journal of the American Society of Nephrology

117

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Prolonged prednisolone treatment for the initial episode of childhood nephrotic syndrome may reduce relapse rate, but whether this results from the increased duration of treatment or a higher cumulative dose remains unclear. We conducted a randomized, double-blind, placebo-controlled trial in 69 hospitals in The Netherlands. We randomly assigned 150 children (9 months to 17 years) presenting with nephrotic syndrome to either 3 months of prednisolone followed by 3 months of placebo (n=74) or 6 months of prednisolone (n=76), and median follow-up was 47 months. Both groups received equal cumulative doses of prednisolone (approximately 3360 mg/m 2 ). Among the 126 children who started trial medication, relapses occurred in 48 (77%) of 62 patients who received 3 months of prednisolone and 51 (80%) of 64 patients who received 6 months of prednisolone. Frequent relapses, according to international criteria, occurred with similar frequency between groups as well (45% versus 50%). In addition, there were no statistically significant differences between groups with respect to the eventual initiation of prednisolone maintenance and/or other immunosuppressive therapy (50% versus 59%), steroid dependence, or adverse effects. In conclusion, in this trial, extending initial prednisolone treatment from 3 to 6 months without increasing cumulative dose did not benefit clinical outcome in children with nephrotic syndrome. Previous findings indicating that prolonged treatment regimens reduce relapses most likely resulted from increased cumulative dose rather than the treatment duration.

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Corticosteroid therapy for nephrotic syndrome in children

Hahn

Hodson

Willis

et al. 2015

Cochrane Database of Systematic Reviews

135

100

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Prolonged versus standard prednisolone therapy for initial episode of idiopathic nephrotic syndrome

Abstract: A prolonged course of prednisolone therapy for an initial episode of nephrotic syndrome can be considered, as it reduces the rate of relapses without increasing the risk for steroid side effects.

Cited by 13 publications

References 0 publications

Multicenter analysis of the efficacy and safety of a non‐standard immunosuppressive therapy with rituximab in children with steroid‐resistant nephrotic syndrome

Multicenter analysis of the efficacy and safety of a non‐standard immunosuppressive therapy with rituximab in children with steroid‐resistant nephrotic syndrome

Extending Prednisolone Treatment Does Not Reduce Relapses in Childhood Nephrotic Syndrome

Corticosteroid therapy for nephrotic syndrome in children

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