Levamisole in steroid dependent and frequently relapsing nephrotic syndrome.

Objective: To determine the efficacy of levamisole in steroid dependent (S.D) and frequently relapsing (F.R) nephrotic, from syndrome (N.S).

Design: Quasi-experimental study.

Place And Duration Of Study: Department of Nephrology at The Children s Hospital, Lahore, over a period of 5 years from January 2000 to December 2004.

Material And Methods: S.D.N.S and F.R.N.S patients between the ages of 1-15 years, were given levamisole on alternate day in a dose of 2.5 mg/kg, if either the dosage of steroids to maintain remission was >1 mg/kg/every other day (EOD), or 0.5 mg/kg/EOD with signs of steroid toxicity. The agent was continued for a period of one year and the steroids were gradually tapered off by 2.5-5 mg every four weeks to less than 0.5 mg/kg/EOD. The patients were monitored for maintenance of remission and side effects of drug.

Results: Seventy patients with a mean age of 5.50+/-2.97 years , with male to female ratio of 4:1 were studied. Nineteen (27.14%) patients did not relapse on therapy, while it was ineffective in 11(15.7%). Rest of 40 (57.14%) patients, though, relapsed during therapy, their duration of remission was prolonged from six months to one year, and dose of corticosteroids could be significantly reduced (0.1-0.3 mg/kg/EOD). It was also observed that levamisole is more effective in older children (>5 years versus <5 years) [P-value 0.03]. The only side effects were transient rash and occasional vomiting.

Conclusion: Levamisole is a safe and effective steroid sparing drug, in steroid dependent and frequently relapsing nephrotic syndrome, for the prolongation of remission, especially in older children.