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

Abstract

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.

Levamisole: adjunctive therapy in steroid dependent minimal change nephrotic children

“…This period was far less than that reported by Dayal et al [15] (12 months). This big difference may be attributed to differences in patient selection.…”

“…Attempts to maintain remission and to prevent relapses often result in several hazards. The immunomodulatory agent levamisole has been used in such cases as an adjunctive therapy [6,15] as a good alternative to major immunosuppressives [16]. However, long term levamisole treatment may be hampered by side effects such as vasculitis [17,18], granulocytopenia, psoriasis-like cutaneous reaction [19], leukemia [20] and gastrointestinal manifestations [6].…”

Long-term effects of levamisole treatment in childhood nephrotic syndrome

“…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.…”

Effect of Oral Levamisole Supplementation to Hepatitis B Vaccination on the Rate of Immune Response in Chronic Hemodialysis Patients

“…However, most patients show little or no response to vaccination due to impaired cellular and humoral immune system function. Levamisole, on the other hand, is an agent used (either alone or combined with interferon) in the treatment of chronic active hepatitis, and it could also be used in immunodepressed patients with nephrotic syndrome and glomerulonephritis to stimulate T cell activity, to enhance B lymphocyte function, and to restore delayed hypersensitivity reactions [8][9][10].…”