Longer Steroid Courses Don’t Affect Recurrence Rate in Nephrotic Syndrome

For children with steroid-sensitive nephrotic syndrome, extending initial steroid therapy from 3 to 6 months does not affect the subsequent relapse rate, reports a trial in Kidney International.

The randomized trial included 219 children with a first episode of steroid-sensitive nephrotic syndrome, enrolled at five academic hospitals in India. After 3 months of standard therapy with prednisolone, 181 children were assigned to receive 3 additional maonths of prednisone or 3 months of placebo therapy. The effects of extended steroid therapy on the risk of future relapse were assessed.

The cumulative initial prednisolone dosage was about 3500 mg/m2 in the 6-month group versus 2800 mg/m2 in the 3-month group. On intention-to-treat analysis, the numbers of steroid-sensitive relapses during the year after randomization were 1.26 and 1.54, respectively. The difference was not significant after adjustment for sex, age, and time to initial remission. The rates of sustained remission, frequent relapses, and adverse steroid effects were similar as well.

For children with idiopathic nephrotic syndrome, multiple relapses are associated with a risk of serious complications and medication-related adverse events. Some reports have suggested that a prolonged course of initial prednisolone therapy can reduce the relapse rate, although these studies have had important limitations.

The new trial finds no reduction in relapse rate for children with steroid-sensitive nephrotic syndrome assigned to 3 months versus 6 months of initial prednisolone therapy. Although extended treatment can postpone the occurrence of initial relapse, the 1-year relapse rates are similar between groups. A Japanese trial comparing 2 months versus 6 months of prednisolone, published in the same issue (Kidney Int 2015; 87:225–232), reaches a similar conclusion [Sinha A, et al. Extending initial prednisolone treatment in a randomized control trial from 3 to 6 months did not significantly influence the course of illness in children with steroid-sensitive nephrotic syndrome. Kidney Int 2015; 87:217–224].