The Effect of Levamisole in Steroid-Dependent Nephrotic Syndrome in Children

ABSTRACT

PURPOSE: Long-term use of steroid, cyclophosphamide and cyclosporin, which are frequently used in the therapy of SDNS, might cause severe side effects. Recently, the immune-modulator levamisole has been tried as a substitute therapy and it has been reported as a method with less side effects and more effectiveness. We started this research in order to observe the effects of levamisole and compare it to other therapy results. PATIENTS AND METHODS: We chose 16 steroid dependent nephrotic syndrome children, those who had shown frequent relapse during the immunocompromised therapy period. Mean age was 9.1+/-.4 years in children and the male to female ratio was 151. All of subjects were diagonized with MCNS and had received cyclophosphamide or cyclosporin before receiving levamisole. Levamisole at a dose of 2.5mg/kg was used every other day for 1 year and the relapse rate was observed. RESULTS: On average of 14 days after treatment, complete remission was visible in all of the children, and the relapse percentage was 50%, which represents 8 children, while remaining 8 children representing 50% of the cases showed no relapse during treatment. During the levamisole therapy period, the average relapse rate was reduced significantly from 2.18+/-.9/year to 0.77+/-.9/year(p=0.027). Also the average relapse rate after the therapy was reduced to 1.34+/-.1/year, which was a significant level compared to the level before treatment(p=0.003). There was no significant difference in terms of duration of remission maintenance. Duration of remission maintenance showed an average of 12.2+/-.1 months before the use of levamisole, but it was also 10.1+/-.9 month after therapy. No other side effects such as leukopenia, skin disease and other clinically significant symptoms appeared at all during therapy. CONCLUSION: The long-term medication of levamisole for the therapy of SDNS children is thought to be able to maintain stable remission by reducing the relapse frequency without causing severe side effects. Further study with a broader range of subjects is required to eluccidate the long-term effects of this treatment.