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Alternate-day prednisone is more effective than intermittent prednisone in frequently relapsing nephrotic syndrome

A report of “Arbeitsgemeinschaft für pädiatrische nephrologie”

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In a multicenter cooperative study the effectiveness and side-effects of two most widely used regimens for prolonged interrupted prednisone treatment were compared in children with frequently relapsing nephrotic syndrome: i.e., alternate-day prednisone vs. intermittent prednisone. Sixty-four children were admitted to the study, 30 of whom were allocated to an alternate-day, 34 to an intermittent group. Sixteen patients did not complete the full trial, which left 48 children for final evaluation (23 alternate-day, 25 intermittent). The protocol consisted of two 6-month periods. During the first 6 months patients received maintenance prednisone (alternate-day = 35 mg/m2/48 h, intermittent = 40 mg/m2 on 3 out of 7 days). During the second 6-month pericd no maintenance prednisone was administered unless a relapse occurred and was treated with a short course of prednisone. The alternate-day prednisone reduced the number of relapsers and the rate of relapses significantly as compared with the control period of the second 6 months. The intermittent prednisone, however, did not significantly lower the number of relapsers, but only the rate of relapses. In the alternate-day group the number of relapsers and the rate of relapses were significantly lower than in the intermittent group. Observation for toxic side-effects did not reveal any difference. It is concluded that an alternate-day regimen is preferable to the intermittent regimen, which should be abandoned in the treatment of children with the nephrotic syndrome.

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Supported by grants of VW Foundation

Participating centers: Basle, Switzerland: Kinderspital (F. Egli) Berlin-West: Universitaets-Kinderklinik Gesamthochschule (H. Olbing, H. J. Bachmann) Frankfurt a. M.: Universitaets-Kinderklinik (J. Dippell) Freiburg i. Br.: Universitaets-Kinderklinik (F. Schidera) Hamburg: Universitaets_Kinderklinik (F. Bläker, H. Altrogge) Hannover: Kinderklinik der Medizinischen Hochschule (J. Brodehl, H.-P. Krohn) und Kinderhielanstalt (J. Natzschka) Heidelberg: Universitaets-Kinderklinik (K. Schärer, D. Müller-Wiefel) Homburg: Universitaets-Kinderklinik (D. Krämer) Munich: Universitaets-Kinderklinik (R. Joppich) Münster: Universitaets-Kinderklinik (L. Diekmann) Stuttgart: Olgaspital (W. Hagge) Pathologist: W. Thoenes (Mainz) Statistician: B. Schneider (Hannover) Central office: Hannover, Kinderklinik der Medizinischen Hochschule (J.B)

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Brodehl, J. Alternate-day prednisone is more effective than intermittent prednisone in frequently relapsing nephrotic syndrome. Eur J Pediatr 135, 229–237 (1981).

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Key words

  • Minimal change nephrotic syndrome
  • Frequent relapsers
  • Alternate-day prednisone
  • Intermittent prednisone
  • Cooperative study