My sixth best paper of 2012 is from a Dutch group and is hot off the presses. Teeninga et al published on-line just 2 days ago in JASN and address an important issue, namely what is more important - duration of steroid therapy or cumulative dose?
Teeninga et al conducted a randomized, double-blind, placebo-controlled trial in 69 hospitals in The Netherlands. They randomly assigned 150 children (9 months to 17 years) who had presented to one of these Dutch centers with nephrotic syndrome to either 3 months of prednisolone followed by 3 months of placebo (n=74) or 6 months of prednisolone (n=76), and median follow-up was 47 months.
Both groups received equal cumulative doses of prednisolone (approximately 3360 mg/m2).
The results were as follows:
Among the 126 children who started trial medication, relapses occurred in 48 (77%) of 62 patients who received 3 months of prednisolone and 51 (80%) of 64 patients who received 6 months of prednisolone.
Frequent relapses, according to international criteria, occurred with similar frequency between groups as well (45% versus 50%).
There were no statistically significant differences between groups with respect to the eventual initiation of prednisolone maintenance and/or other immunosuppressive therapy (50% versus 59%), steroid dependence, or adverse effects.
The bottom-line is that extending initial prednisolone treatment from 3 to 6 months without increasing cumulative dose does not benefit clinical outcome in children with nephrotic syndrome. This would then suggest, albeit unproven, that the benefit of prolonged treatment regimens to reduce relapses is most likely due to increased cumulative dose rather than treatment duration.
Teeninga et al conducted a randomized, double-blind, placebo-controlled trial in 69 hospitals in The Netherlands. They randomly assigned 150 children (9 months to 17 years) who had presented to one of these Dutch centers with nephrotic syndrome to either 3 months of prednisolone followed by 3 months of placebo (n=74) or 6 months of prednisolone (n=76), and median follow-up was 47 months.
Both groups received equal cumulative doses of prednisolone (approximately 3360 mg/m2).
The results were as follows:
Among the 126 children who started trial medication, relapses occurred in 48 (77%) of 62 patients who received 3 months of prednisolone and 51 (80%) of 64 patients who received 6 months of prednisolone.
Frequent relapses, according to international criteria, occurred with similar frequency between groups as well (45% versus 50%).
There were no statistically significant differences between groups with respect to the eventual initiation of prednisolone maintenance and/or other immunosuppressive therapy (50% versus 59%), steroid dependence, or adverse effects.
The bottom-line is that extending initial prednisolone treatment from 3 to 6 months without increasing cumulative dose does not benefit clinical outcome in children with nephrotic syndrome. This would then suggest, albeit unproven, that the benefit of prolonged treatment regimens to reduce relapses is most likely due to increased cumulative dose rather than treatment duration.
