Duration of steroid treatment protocols for children with newly diagnosed idiopathic nephrotic syndrome could possibly be adjusted based on clinical response, a study shows, lowering the cumulative steroid dose and avoiding unnecessary exposure. The nonrandomized pilot trial included 59 children with newly diagnosed idiopathic nephrotic syndrome treated between 2014 and 2019 who responded to treatment within 8 days. Of these, 27 children received a response-adjusted protocol during which responders received an 8-week course of tapering doses of prednisone. The standard protocol (prednisone, 60 mg/m2/24 hours for 6 weeks, followed by 40 mg/m2/48 hours for 4 weeks, followed by a slow taper for a total of 24 weeks) was used in a usual care group of 32 patients.
The investigators report these results: “The consent rate was 88%. The mean cumulative steroid dose for the initial treatment was 70 mg/kg and 141 mg/kg (P < 0.001) in the intervention and usual care groups, respectively. None of the patients in the intervention group relapsed while on faster steroid taper down. The occurrence of [frequently relapsing or steroid-dependent nephrotic syndrome] in the intervention group was not statistically different than in the usual care group, hazard ratios were 0.80 (95% CI, 0.37–1.73) and 0.61 (95% CI, 0.30–1.27), respectively. The proportions of relapse-free patients were similar (P = 0.5), and adverse steroid events did not differ between the groups.”
“These findings demonstrate the feasibility of a shortened duration of steroid dosing for idiopathic nephrotic syndrome when patients demonstrate an initial clinical response to treatment,” the authors conclude. “A larger study is needed to characterize the relative efficacy and toxicity of this novel treatment regimen.”