Evaluation of levamisole efficacy in the treatment of steroid dependent and/or frequently relapsing idiopathic nephrotic syndrome in children

Background: Steroid dependent (SDNS) and/or frequently relapsing idiopathic nephrotic syndrome (FRINS) is a therapeutic problem. This study was conducted to determine the effect of Levamisole in children with steroid dependent and/or frequently relapsing nephrotic syndrome.

Methods: In this Quasi-experimental study, 43 children aged 1-14 years with steroid dependent (23 cases) and/or frequently relapsing (20 cases) nephrotic syndrome was studied. The patients were treated with prednisolone (60/mg/m2/day) for four weeks. Then steroid was tapered (40 mg/m2 /48 h) and simultaneously Levamisole (2.5 mg/ kg/48 h) was administrated. The patients were monitored every month for remission, relapse and side effects of drug. Data were analyzed using Paired-Sample T Test, Independent-Sample T Test, Wilcoxon Signed Ranks Test, Chi- Square Test and SPSS 11.5 for windows package.

Results: After initiation of Levamisole, full and partial remission was showed in 46.5% and 34.9% respectively. 18.6% didn't respond to Levamisole. 39.5% remained in remission for more than one year. The mean relapse rate per annum was reduced from 2.7±1 times before to 1.1±1.2 times after administration of Levamisole (P<0.001). There were significant statistical differences between Levamisole response with type of NS and age of NS onset.

Conclusion: According to Levamisole effect on complete or partial remission, reduction of relapse rate, increased interval between relapses and reduction of steroid dosage without a significant side effects we can conclude that Levamisole is effective and safe steroid sparing drug in children with FRINS and SDNS, therefore, it could be recommended for these patients.