Levamisole Therapy in Corticosteroid Dependent Nephrotic Syndrome

Source: Pediatric Nephrology. 11(4): 415-417. August 1997.

Contact: Available from Springer-Verlag. Service Center Secaucus, 44 Hartz Way, Secaucus, NJ 07094. (201) 348-4033.

Summary: This article reports on a study in which the effect of prolonged treatment with levamisole was examined in 43 patients (30 boys, 13 girls) with steroid dependent nephrotic syndrome (SDNS). Levamisole is a drug that modulates phagocytic (cells that surround and digest microorganisms and cellular debris) and lymphocytic (white blood cells that assist in immune function) activity. Nephrotic syndrome is a condition characterized by massive edema (fluid accumulation), heavy proteinuria (protein in the urine), hypoalbuminemia (low levels of protein in the blood), and susceptibility to infections. The mean age at the beginning of treatment was 4.0 years (plus or minus 2 years). Fourteen patients had previously received cyclophosphamide with an ensuring remission of 8.5 months (plus or minus 10 months). Following induction of remission with prednisolone, levamisole was administratered at a dose of 2.5 milligrams per kilogram of body weight on alternate days. Prednisolone was tapered to 0.5 milligrams per kilogram of body weight on alternate days. The duration of levamisole therapy ranged from 6 to 31 months; 15 patients received levamisole for more than 18 months and 10 for more than 24 months. Prednisolone was discontinued in 18 patients after a mean duration of 11.7 months, whereas in 21 patients, its dose was reduced to 0.2 to 0.4 milligrams per kilogram of body weight on alternate days. The mean relapse rate prior to levamisole therapy was 3.0 relapses per year, which reduced to 0.9 relapses per year during levamisole treatment. A comparison of the response in 14 patients who had previously received cyclophosphamide with the other 29 patients did not show any significant difference. There were no side effects of levamisole therapy The authors conclude that treatment with levamisole is beneficial and safe in SDNS, with a marked steroid sparing effect. A significant proportion of these patients can be kept in remission on levamisole alone. 3 tables. 16 references.

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