A Cochrane review [Abstract] 1 included 48 studies (3 941 participants) on corticosteroid regimens in preventing relapse in children with steroid sensitive nephrotic syndrome (SSNS).
There was little or no difference in the number of children with frequent relapses when comparing 2 months of prednisone with 3 months or more (RR 0.86, 95% CI 0.71 to 1.06; 8 studies, n=976) or when comparing 3 months with 5 to 7 months of therapy (RR 0.73, 95% CI 0.49 to 1.09; 6 studies, n=706; statistical heterogeneity I2 =68%) in children with their initial episode of SSNS.
Therapy for 3 months or more reduced the number of children relapsing by 12 to 24 months compared to 2 months of prednisone (RR 0.77, 95% CI 0.63 to 0.95; 12 studies, n=1 309; statistical heterogeneity I2 =77%) and 5 to 7 months of therapy reduced the number of children relapsing by 12 to 24 months compared to 3 months of therapy (RR 0.62, 95% CI 0.45 to 0.85; 7 studies, n=762; statistical heterogeneity I2 = 83%). However, in analyses of 8 studies at low risk of selection bias, there was little or no difference in the number of children with any relapse by 12 to 24 months when comparing 2 months of prednisone with 3 months or more (RR 0.91, 95% CI 0.78 to 1.06; 5 studies, n=637) or when comparing 3 months with 5 to 7 months of therapy (RR 0.88, 95% CI 0.70 to 1.11; 3 studies, n=377; I2 = 53%).
Little or no difference was noted in adverse effects between the different treatment durations. One study found a reduced risk of relapse with low daily dosing compared with alternate daily dosing (MD -0.90 number of relapses/year, 95% CI -1.33 to -0.47). Four studies found that in children with frequently relapsing nephrotic syndrome (FRNS), daily prednisone during viral infections compared with alternate-day prednisone or no treatment significantly reduced the rate of relapse.
Primary/Secondary Keywords