EFFICACY OF LEVAMISOLE AS A SINGLE AGENT IN MAINTAINING REMISSION IN STEROID DEPENDANT NEPHROTIC SYNDROME

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 randomised 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.

[1]  D. Laub,et al.  Levamisole-Induced Vasculitis , 2018, Eplasty.

[2]  Djalila Mekahli,et al.  Long-term outcome of idiopathic steroid-resistant nephrotic syndrome: a multicenter study , 2009, Pediatric Nephrology.

[3]  M. Somers,et al.  Short- and long-term efficacy of levamisole as adjunctive therapy in childhood nephrotic syndrome , 2008, Pediatric Nephrology.

[4]  J. Dötsch,et al.  Treatment of severe steroid-dependent nephrotic syndrome (SDNS) in children with tacrolimus. , 2006, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[5]  K. Mirza,et al.  Experience with levamisole in frequently relapsing, steroid-dependent nephrotic syndrome , 2006, Pediatric Nephrology.

[6]  S. Jordan,et al.  Atopy, serum IgE, and interleukin-13 in steroid-responsive nephrotic syndrome , 2004, Pediatric Nephrology.

[7]  A. Bakkaloğlu,et al.  T-cell subsets, interleukin-2 receptor expression and production of interleukin-2 in minimal change nephrotic syndrome , 1994, Pediatric Nephrology.

[8]  T. Barratt,et al.  Lymphocyte subpopulations, interleukin-2 and interleukin-2 receptor expression in childhood nephrotic syndrome , 1994, Pediatric Nephrology.

[9]  L. Rees,et al.  The use of steroid-sparing agents in steroid-sensitive nephrotic syndrome , 2003, Pediatric Nephrology.

[10]  J. Ehrich,et al.  A meta-analysis of cytotoxic treatment for frequently relapsing nephrotic syndrome in children , 2001, Pediatric Nephrology.

[11]  C. Chi,et al.  Levamisole in steroid-sensitive nephrotic syndrome children with steroid-dependency and/or frequent relapses. , 2000, Acta paediatrica Taiwanica = Taiwan er ke yi xue hui za zhi.

[12]  S. Jordan,et al.  Th1 and Th2 cytokine mRNA profiles in childhood nephrotic syndrome: evidence for increased IL-13 mRNA expression in relapse. , 1999, Journal of the American Society of Nephrology : JASN.

[13]  A. Bagga,et al.  Levamisole therapy in corticosteroid-dependent nephrotic syndrome , 1997, Pediatric Nephrology.

[14]  D. Bulugahapitiya.  Liver toxicity in a nephrotic patient treated with levamisole , 1997, Archives of disease in childhood.

[15]  J. Książek,et al.  [Evaluation of the efficacy of levamisole in corticosteroid-dependent nephrotic syndrome in children]. , 1995, Pediatria polska.

[16]  A. Cambon-Thomsen,et al.  Clinical implications from studies of HLA antigens in idiopathic nephrotic syndrome in children. , 1995, Clinical nephrology.

[17]  T. Barratt,et al.  Consensus statement on management and audit potential for steroid responsive nephrotic syndrome. Report of a Workshop by the British Association for Paediatric Nephrology and Research Unit, Royal College of Physicians. , 1994, Archives of disease in childhood.

[18]  British Association For Paediatric Nephrology.  Levamisole for corticosteroid-dependent nephrotic syndrome in childhood , 1991, The Lancet.

[19]  J. Brodehl.  Conventional therapy for idiopathic nephrotic syndrome in children. , 1991, Clinical nephrology.

[20]  G. Duggin,et al.  Malignant lymphoma in a renal transplant patient on cyclosporin A therapy. , 1989, Australian and New Zealand journal of medicine.

[21]  R. del Gado,et al.  Levamisole in children's idiopathic nephrotic syndrome. , 1988, Child nephrology and urology.

[22]  J. Lilleyman.  Minimal change nephrotic syndrome and cyclophosphamide. , 1987, Archives of disease in childhood.

[23]  P. Miller.  Immunoregulatory treatment for minimal change nephrotic syndrome. , 1986, Archives of disease in childhood.

[24]  K. Mehta,et al.  Immunoregulatory treatment for minimal change nephrotic syndrome. , 1986, Archives of disease in childhood.

[25]  R. White,et al.  LONG-TERM OUTCOME FOR CHILDREN WITH MINIMAL-CHANGE NEPHROTIC SYNDROME , 1985, The Lancet.

[26]  S. Chatasingh,et al.  Treatment of nephrotic syndrome with levamisole. , 1980, The Journal of pediatrics.

[27]  R. Shalhoub.  Pathogenesis of lipoid nephrosis: a disorder of T-cell function. , 1974, Lancet.