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

PURPOSE: In this study, we aimed to evaluate short- and long-term effects of levamisole therapy in steroid-sensitive nephrotic syndrome (SSNS) in children.
METHODS: 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).
RESULTS: 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.
CONCLUSION: Thus, our study showed that levamisole is a safe and effective steroid-sparing agent, with long-lasting effect even 12 months after withdrawal.