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Efficacy of higher-dose levamisole in maintaining remission in steroid-dependant nephrotic syndrome

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Abstract

Objective

Levamisole (LEV) has been used successfully on an alternate-day regime of 2.5 mg/kg in steroid-dependant nephrotic syndrome (SDNS) to maintain remission. This pilot study was carried out between 2010 and 2015 at a single center in Sri Lanka to evaluate the efficacy of LEV prescribed at 2.5 mg/kg daily, which is double the alternate-day dose.

Methods

Sequential children with SDNS, relapsing more than twice in the preceding 12 months and previously treated with LEV and low-dose alternate-day prednisolone (0.1–0.6 mg/kg) were recruited to the study. This group received LEV (2.5 mg/kg) daily with the same dose of alternate-day prednisolone for 1 year. Urine protein excretion was recorded by parents on a daily basis, and the presence of 3+ proteinuria on 3 consecutive days was considered a relapse. Full blood counts and liver function tests were performed every 3 months to monitor for adverse effects.

Results

Sixty-four children were enrolled into the study; six were excluded due to prescription of other immunosuppressive drugs. Median age was 7.9 years; 33 were boys. The number of relapse episodes was 163 [mean per patient 2.8 ± standard deviation (SD) 0.8] in patients on alternate-day LEV and 77 (mean 1.3 ± SD 0.9) for those on daily LEV during the 12-month period of observation. The P value 0.000 (according to the Wilcoxon signed-rank test) was <0.001. No major adverse events were noted.

Conclusions

The prescription of daily LEV is effective and safe for maintaining SDNS remission.

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Authors and Affiliations

  1. Department of Paediatrics, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka

    Asiri S. Abeyagunawardena, Umeshi Karunadasa, Heshan Jayaweera & Shenal Thalgahagoda

  2. Department of Community Medicine, University of Peradeniya, Peradeniya, Sri Lanka

    Sampath Tennakoon

  3. Outpatient Department, Teaching Hospital Peradeniya, Peradeniya, Sri Lanka

    Shamali Abeyagunawardena

Authors
  1. Asiri S. Abeyagunawardena
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  2. Umeshi Karunadasa
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  3. Heshan Jayaweera
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  4. Shenal Thalgahagoda
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  5. Sampath Tennakoon
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  6. Shamali Abeyagunawardena
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Corresponding author

Correspondence to Asiri S. Abeyagunawardena.

Ethics declarations

All procedures performed in the study were in accordance with the ethical standards of the Scientific and Ethics committee, Faculty of Medicine of the University of Peradeniya and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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The authors declare that they have no conflict of interest.

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Abeyagunawardena, A.S., Karunadasa, U., Jayaweera, H. et al. Efficacy of higher-dose levamisole in maintaining remission in steroid-dependant nephrotic syndrome. Pediatr Nephrol 32, 1363–1367 (2017). https://doi.org/10.1007/s00467-017-3616-5

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  • DOI: https://doi.org/10.1007/s00467-017-3616-5

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