USE OF LEVAMISOLE IN MAINTAINING REMISSION IN STEROID-SENSITIVE NEPHROTIC SYNDROME IN CHILDREN

A randomized, controlled trial was conducted in a pediatric unit in a teaching hospital in India to assess the efficacy of levamisole in mai ntaining remission in children with steroid-sensitive nephrotic syndro me. Sixty-one children with steroid-sensitive nephrotic syndrome, who had achieved remission with corticosteroids, were allocated to a treat ment group (33 patients) receiving levamisole (2-3 mg/kg/day) twice a week for 12 months or to a control group (28 patients) receiving no tr eatment. The main outcome measure was duration of remission. Thirty mo nths later, in the levamisole group, 21 of 33 patients were in remissi on as against 12 of 28 patients in the control group (chi2 = 2.54, p = 0.11, NS). The median duration of remission maintenance was 12 months in the levamisole group as compared with 10.5 months in the control g roup. On survival analysis, the difference in duration of remission ma intenance between the two groups was not significant (p = 0.10), thoug h there was a trend in favor of the treatment group. On stratified sur vival analysis, multiple relapsers in the levamisole group had longer remission maintenance than the control group though this did not reach statistical significance (p = 0.08). The clinically significant trend towards increased duration of remission maintenance in steroid-sensit ive nephrotic syndrome observed with levamisole therapy, especially in patients with multiple relapses, may require a larger study with a lo nger follow-up for definitive confirmation.