Kiruba Samuel Evangeline Mary, Krishnamurthy Sriram, Bhanudeep Singanamalla, Muske Sravani
Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India. Correspondence to: Dr Sriram Krishnamurthy, Additional Professor, Department of Pediatrics, JIPMER, Pondicherry 605 006, India.
Indian Pediatr. 2017 Oct 15;54(10):831-834. doi: 10.1007/s13312-017-1144-9. Epub 2017 Jul 11.
To evaluate the efficacy of levamisole in children with frequently relapsing nephrotic syndrome (FRNS) and steroid dependent nephrotic syndrome (SDNS) when administered on an alternate day ('initial therapy' in all cases) or daily basis ('rescue therapy' in whom alternate day therapy failed).
The records of 95 children (age 1-18y) with FRNS (62) and SDNS (33), who were treated at the Pediatric nephrology clinic, and received levamisole therapy (maximum 2 y duration, between 2010-2013) with a follow-up period of minimum 1 y, were included.
Alternate day levamisole therapy was efficacious in 73.7% (n=70). The overall efficacy of levamisole therapy was 88.4% (n=84). Levamisole therapy decreased the mean (SD) number of relapses from 4.22 (0.46)/y to 1.35 (0.36)/y (P<0.01); and cumulative median (IQR) prednisolone dosage from 4200 (3200-4300) mg/m2 to 1100 (IQR 500-2900) mg/m2 (P<0.001). On a one-year follow up of the cases in whom levamisole therapy was efficacious during therapy (median 24 mo) (n=84), a frequently relapsing or steroid dependent course continued to persist in 48.8% (41), necessitating oral cyclophosphamide (n= 22) or mycophenolate mofetil (n=19).
Daily levamisole therapy was useful in 56% of children who demonstrated failure while on alternate day levamisole therapy, and could be a useful therapeutic option in FRNS and SDNS.
评估左旋咪唑在频繁复发肾病综合征（FRNS）和激素依赖型肾病综合征（SDNS）儿童中隔日给药（所有病例均为“初始治疗”）或每日给药（隔日治疗失败时为“挽救治疗”）的疗效。
纳入95例年龄1至18岁的FRNS患儿（62例）和SDNS患儿（33例），这些患儿在儿科肾脏病门诊接受治疗，2010年至2013年间接受左旋咪唑治疗（最长疗程2年），随访期至少1年。
隔日左旋咪唑治疗有效率为73.7%（n = 70）。左旋咪唑治疗的总有效率为88.4%（n = 84）。左旋咪唑治疗使复发的平均（标准差）次数从4.22（0.46）次/年降至1.35（0.36）次/年（P < 0.01）；累积泼尼松龙剂量中位数（四分位间距）从4200（3200 - 4300）mg/m²降至1100（四分位间距500 - 2900）mg/m²（P < 0.001）。对治疗期间左旋咪唑治疗有效的病例（中位数24个月）（n = 84）进行1年随访，48.8%（41例）仍持续频繁复发或依赖激素，需要口服环磷酰胺（n = 22）或霉酚酸酯（n = 19）。
每日左旋咪唑治疗对56%隔日左旋咪唑治疗失败的儿童有用，可能是FRNS和SDNS的一种有效治疗选择。
