No advantage to prolonged prednisone in young children with nephrotic syndrome

Reuters Health - 08/11/2021 - In young children with idiopathic nephrotic syndrome, there is no advantage to extending initial prednisone therapy beyond the standard three months, new research indicates.

Prolonging initial therapy to six months does not significantly impact key outcomes including the frequency of relapses, lead author Dr. Aditi Sinha said in a presentation of the results at a press briefing during Kidney Week 2021, hosted by the American Society Nephrology (ASN).

"While overall a rare condition, idiopathic nephrotic syndrome is one of the leading causes of chronic kidney disease in childhood," Dr. Sinha, of the All India Institute of Medical Sciences in New Delhi, explained.

The majority of patients respond to corticosteroid therapy and have a favorable long-term outcome. However, more than a third will suffer frequent relapses and some studies have suggested that extending initial prednisone therapy from the standard three weeks to six weeks may reduce the risk of subsequent relapses in children younger than 6 years, she explained.

To investigate, the researchers did an open label, multicenter study in 172 children under 4 with idiopathic nephrotic syndrome; half were randomly allocated to the standard 12 weeks of prednisone and half to extended therapy for six months.

At the one-year follow-up, patients treated for six months for the initial episode of steroid-sensitive nephrotic syndrome had "similar or only slightly improved" outcomes compared with those getting standard treatment, Dr. Sinha reported.

Similar proportions of children were in sustained remission (28% with standard therapy vs. 39% with extended therapy; P=0.11), with no significant difference in the frequency of relapses (3.0 vs. 2.2, respectively; P=0.10) or in the proportion with frequent relapses (48% vs. 45%; P=0.76).

Time to relapse was also comparable in the standard and extended therapy groups (4.2 and 7.4 months, respectively, P=0.12).

"Based on these results, there appears to be no advantage to extending initial therapy beyond three months in young children with steroid-sensitive nephrotic syndrome. Young children with the first episode of nephrotic syndrome should receive similar treatment as older children," Dr. Sinha concluded.

SOURCE: https://bit.ly/3CUIO6m Kidney Week 2021, held November 4-7, 2021.

By Megan Brooks



Posted on 8 November 20219 November 2021