Researchers from Great Ormond Street Hospital in London conducted 2 studies to evaluate the effectiveness of low-dose prednisone in treating relapse in children with steroid-sensitive nephrotic syndrome (SSNS). The retrospective analysis included healthy children with SSNS who started taking 1 mg/kg prednisone daily for ≥7 days to treat relapsing SSNS between January 2012 and July 2013 at 2 sites in London. The current treatment in the UK for children with relapsing SSNS is typically 2 mg/kg/d until complete remission for at least 3 days. For the study, a relapse was defined as significant proteinuria according to a dipstick test for at least 3 consecutive days, and remission was defined as 0 or trace proteinuria for at least 3 days. The main outcome was the proportion of patients achieving remission on the low-dose regimen; the relapse rate in the 6 months prior to and the 6 months after the index relapse in each child was compared by using a paired t test. The second study was a random selection of the patients in the initial study who had been treated with both standard-dose and low-dose prednisone for different relapses. In July 2015, parents of the selected study patients completed separate PedsQL 4.0 questionnaires to assess their child’s quality of life (QOL) in 4 separate domains during relapses treated with the standard- or low-dose regimens.
A total of 50 children aged 3–17 years (mean, 9.1 years) were included in the primary investigation. In all, 87 relapses occurred; remissions were achieved by using the low-dose regimen in 61 (70%). The mean number of relapses in the 6 months prior to the index relapse in study patients was 1.01, compared to a mean of 0.86 relapse per patient in the subsequent 6 months (P = .30). Parents of 15 study children subsequently completed PedsQL 4.0 questionnaires. For each of the 4 domains, scores were significantly higher (indicating higher QOL) when parents rated their child’s QOL during low-dose treatment compared to standard-dose treatment of relapses.
The authors conclude that a low-dose prednisone regimen helped to achieve remission in 70% of relapses in children with SSNS without compromising the relapse rate and was associated with higher QOL when compared to standard-dose treatment.
Dr. Singer has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
Minimal-change nephrotic syndrome, one of the most commonly encountered glomerular diseases of childhood, is defined by its overall sensitivity to corticosteroids. Approximately 80% of patients with minimal-change nephrotic syndrome respond to steroids1 , and a 2–3-month course is standardly prescribed at initial presentation, with shorter courses used for relapses. While effective at achieving remission, prolonged steroid courses result in...