Short- and long-term efficacy of levamisole in children with steroid-sensitive nephrotic syndrome

In this study, we aimed to evaluate short- and long-term effects of levamisole therapy in steroid-sensitive nephrotic syndrome (SSNS) in children. The study consisted of 29 SSNS patients who had been treated with levamisole for 12 months. Laboratory values and clinical data were analyzed for three separate periods for each patient: 1 year prior to the initiation of levamisole therapy (Pre-Lev), during 1 year of levamisole therapy (During-Lev), and the year following cessation of levamisole therapy (End-Lev). The level of proteinuria fell from median 135.0 (24.0-633.0) mg/h/m(2) Pre-Lev to median 4.4 (2.4-654.0) mg/h/m(2) During-Lev and median 4.8 (2.2-105.0) mg/h/m(2) End-Lev (p = 0.0001, for each). Median relapse frequency fell from 4.0 (3.0-8.0) relapses/patient per year Pre-Lev to 0.0 (0.0-2.0) During-Lev (p = 0.0001) with 23/29 patients having no relapse and 0.0 (0.0-1.0) End-Lev (p = 0.0001) with 18/29 patients without relapse. During-Lev, all children had marked diminution in annual steroid burden from a median of 5582.0 (2137.0-17340.0) mg/m(2) per year Pre-Lev to 2166.0 (840.0-9325.0) mg/m(2) per year (p = 0.0001). End-Lev, the annual steroid burden also continued to fall, to 0.0 (0.0-5386.0) mg/m(2) per year (p = 0.0001). The age and duration of NS were significantly higher in the children with relapses than in the children with sustained remission (p = 0.009 and p = 0.014, respectively). The side effects that are expected during levamisole therapy did not occur in our patients. Thus, our study showed that levamisole is a safe and effective steroid-sparing agent, with long-lasting effect even 12 months after withdrawal.