Summary
This multi-center randomized trial [1] in children with steroid sensitive nephrotic syndrome (NS) compared prednisolone therapy for 2 months versus 6 months. Authors evaluated time to occurrence of frequent relapse, time to first relapse, and various adverse events in 255 children (1–15 years) from 90 Japanese hospitals presenting with first episode of NS. Those who achieved remission within 3 weeks of prednisolone therapy were randomized to either 6 months therapy [60 mg/m2 daily for 4 wk, gradually (4 weekly) tapering alternate day doses for next 24 wk] or 2 months therapy (60 mg/m2 daily for 4 wk, 40 mg/m2 alternate day for 4 wk) with oral prednisolone. Children were followed up for at least 2 years. The authors reported comparable (i) time to frequent relapses (RR 0.86, 95% CI 0.64, 1.16), (ii) episodes of relapse (RR 0.92, 95% CI 0.75, 1.14), (iii) frequent relapses (RR 0.99, 95% CI 0.72, 1.38), (iv) time to first relapse, (v) relapse rate per person-year, and (vi) adverse effects (hypertension, cushingoid facies, glaucoma, and elevated hepatic enzymes). The authors also presented a meta-analysis comparing trials using 2–3 versus 5–6 months therapy, and reported comparable results. They suggested that 2 months of prednisolone is not inferior to 6 months therapy.
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Sinha, A., Bagga, A., Iyengar, A. et al. Is two month initial prednisolone treatment for nephrotic syndrome inferior to longer duration therapy ?. Indian Pediatr 51, 811–817 (2014). https://doi.org/10.1007/s13312-014-0508-7
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DOI: https://doi.org/10.1007/s13312-014-0508-7