Document Detail


Extending prednisolone treatment does not reduce relapses in childhood nephrotic syndrome.
MedLine Citation:
PMID:  23274956     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Prolonged prednisolone treatment for the initial episode of childhood nephrotic syndrome may reduce relapse rate, but whether this results from the increased duration of treatment or a higher cumulative dose remains unclear. We conducted a randomized, double-blind, placebo-controlled trial in 69 hospitals in The Netherlands. We randomly assigned 150 children (9 months to 17 years) presenting with nephrotic syndrome to either 3 months of prednisolone followed by 3 months of placebo (n=74) or 6 months of prednisolone (n=76), and median follow-up was 47 months. Both groups received equal cumulative doses of prednisolone (approximately 3360 mg/m(2)). Among the 126 children who started trial medication, relapses occurred in 48 (77%) of 62 patients who received 3 months of prednisolone and 51 (80%) of 64 patients who received 6 months of prednisolone. Frequent relapses, according to international criteria, occurred with similar frequency between groups as well (45% versus 50%). In addition, there were no statistically significant differences between groups with respect to the eventual initiation of prednisolone maintenance and/or other immunosuppressive therapy (50% versus 59%), steroid dependence, or adverse effects. In conclusion, in this trial, extending initial prednisolone treatment from 3 to 6 months without increasing cumulative dose did not benefit clinical outcome in children with nephrotic syndrome. Previous findings indicating that prolonged treatment regimens reduce relapses most likely resulted from increased cumulative dose rather than the treatment duration.
Authors:
Nynke Teeninga; Joana E Kist-van Holthe; Nienske van Rijswijk; Nienke I de Mos; Wim C J Hop; Jack F M Wetzels; Albert J van der Heijden; Jeroen Nauta
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of the American Society of Nephrology : JASN     Volume:  24     ISSN:  1533-3450     ISO Abbreviation:  J. Am. Soc. Nephrol.     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2012-12-31     Completed Date:  2013-03-04     Revised Date:  2014-01-09    
Medline Journal Info:
Nlm Unique ID:  9013836     Medline TA:  J Am Soc Nephrol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  149-59     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Child
Child, Preschool
Double-Blind Method
Female
Glucocorticoids / administration & dosage*
Humans
Male
Nephrotic Syndrome / drug therapy*
Prednisolone / administration & dosage*
Recurrence / prevention & control
Chemical
Reg. No./Substance:
0/Glucocorticoids; 9PHQ9Y1OLM/Prednisolone
Comments/Corrections
Comment In:
J Am Soc Nephrol. 2013 Jan;24(1):7-9   [PMID:  23243214 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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