Levamisole in steroid-sensitive nephrotic syndrome children with frequent relapses and/or steroid dependency: comparison of daily and every-other-day usage

Abstract

Steroid dependency (SD) and frequent relapses (FR) are common with steroid-sensitive nephrotic syndrome (SSNS). We assessed the effectiveness of daily levamisole in 36 children with SSNS with FR and/or SD. Twenty patients (group 1) were given levamisole 2-3 mg/kg q.o.d. for 4-24 months. Sixteen (group 2) had relapses within 3 months: 5 received levamisole q.d. for 3-18 months, and 11 q.d. for 6 months and then q.o.d. for 4-18 months. Follow-up was 4-36 (mean 20.4 +/- 9.2) months. After therapy, relapses (4.82 +/- 3.15 vs. 2.01 +/- 2.5 in group 1; 5.97 +/- 3.38 vs. 1.34 +/- 2.1 in group 2; p < 0.05) and prednisolone doses (0.57 +/- 0.37 vs. 0.15 +/- 0.33 mg/kg/day in group 1; 0.61 +/- 0.42 vs. 0.19 +/- 0.35 mg/kg/day in group 2; p < 0.05) decreased. Relapse frequency, prednisolone dose, response percentage, and survival curves for remission did not differ between groups. Group 1 had five episodes of leukopenia, and group 2 had four. White blood cell counts normalized after levamisole was discontinued. Serum blood urea nitrogen/creatinine and alanine aminotransferase/aspartate aminotransferase levels were normal. Levamisole is effective in maintaining remission in children with SSNS and FR and/or SD. Daily levamisole can be considered when responses to q.o.d. usage are unsatisfactory.