Prolonged corticosteroid regimen with slow monthly tapering course is effective for the initial episode of steroid sensitive nephrotic syndrome; Evidence from a Randomized control trial

Abstract

Abstract Background The benefits of prolonged steroid therapy in the initial episode Steroid Sensitive Nephrotic Syndrome (SSNS) has been challenged. This study was conducted to determine whether prolonged corticosteroid regimen for the initial episode of SSNS resulting in highly favorable results with slow monthly tapering course against prolonged regimen with steep dose reduction and rapid tapering course. Methods A randomized control trial was conducted among 65 children aged 1-12years with nephrotic syndrome after achieve remission with daily prednisolone for 28 days. They were randomized into two groups based on prednisolone regimen; Author Experimental Regimen (AER)(n = 32) and Kidney Disease Improving Global outcome (KDIGO)(n = 33) regimen. AER group (total 7 months) received a prolonged prednisolone regimen with slow monthly tapering course. KDIGO regimen group received prolonged regimen with steep dose reduction and rapid tapering course. Both groups were followed up to three years at 6-month, 12-month, 24 month and 36 months respectively. Results The mean (SD) duration of remission following the initial episode was significantly prolonged in the AER group compared to the KDIGO group (17.3 vs 8.4 months). Relapse rate, relative risk for relapse, cumulative relapse status and incidence of steroid dependence were statistically significantly very low in AER group. Children in AER group had lower risk to develop adverse events due to steroid therapy. Conclusion The prolonged corticosteroid regime with a slow monthly tapering course showed a highly favorable results for the initial episode of SSNS. Hence, AER is recommended to manage children with initial episode of SSNS to achieve better outcome.