Efficacy of Levamisole as a single agent in maintaining remission in steroid dependant nephrotic syndrome

Abstract

Introduction Levamisole (LEV) is an anti-helminthic drug which subsequently has shown immunomodulatory properties. It has been used successfully in conjunction with low-dose alternate-day prednisolone in steroid dependant nephrotic syndrome (SDNS). This randomized controlled study was carried out between years 2002 and 2005 at a single centre in Sri Lanka to evaluate the efficacy of LEV as a single agent following a prolonged period of combination therapy of LEV and prednisolone. Method Sequential Children with SDNS in stable remission who had been treated with LEV and low dose alternate-day prednisolone (0.1-0.6mg/kg) for 2 years were recruited and randomised into one of two groups. The test group received LEV (2.5 mg/kg) on alternate-days for one year and the control group received no treatment. Urine protein excretion was performed and recorded by parents on daily basis and the finding of 3+ or more proteinuria for three consecutive days was diagnostic of relapse. Results There were 42 in the test group (median age 8.4 years) and 34 in the control group (median age 7.2 years). During one year of follow up, 26/34 in the control group and 8/42 in the test group suffered a relapse. (p< 0.001 comparison of 2 proportions using Standard Error. CI-0.105 to 0.49). No adverse effects of LEV were encountered. Conclusion Levamisole is safe, affordable and effective as a single agent in maintaining remission in SDNS.

Keywords

• levamisole
• single agent
• long-term therapy
• steroid-dependent nephritic syndrome