1 - Unidade de Nefrologia, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central, EPE, Lisboa;
2 - Unidad de Nefrología Pediatrica, Hospital Universitario La Paz, Madrid
- 47th ESPN Annual Scientific Meeting of the European Society of Paediatric Nephrology, 18-20/9/2014, Porto (Poster)
- Revista Pediatr Nephrol 2014;29(9):1742-43
Introduction: Levamisole is a low-toxicity drug used on treatment of steroid-dependent nephrotic syndrome with multiple relapses.
Material and methods: Retrospective study performed by consultation of clinical records of all our patients with nephrotic syndrome treated with levamisole for at least 6 months, from May/1990 until January/2013. Number of relapses and cumulative dose of steroids were evaluated. Statistical analysis was performed with SPSS17® (T student´s test), with a significance level of p<0.05.
Results: 22 of our patients were treated with levamisole, but 5 were excluded (clinical records not available/incomplete, incomplete adherence to treatment). Of the patients included, 58.8% were male. The median age of inaugural episode of nephrotic syndrome was 51 months. Median interval between diagnosis and initiation of levamisole was 25 months. All patients were medicated with prednisole alone before starting levamisole (median: 11months). Cyclosphosphamide (35.5%) and mycophenolate mofetil (5,9%) were other therapeutics tried before levamisole. The median duration of treatment with levamisole was 13 months (6-39). In the year before levamisole, there was an average of 0.29 relapses/patient/month; with one year of treatment there was a decline to 0.26(p=0.04) and after two years of treatment to 0.01relapses/patient/month (p=0.01). In the year after suspension of levamisol there was 0.06 relapses/patient/month. The interval between onset of levamisole and recurrence was 1.2 months and after suspension of levamisole was 7.3 months. In the year before levamisole cumulative prednisolone dose was 556.4mg/m2/month, one year after starting treatment was 52.4mg/m2/month (p=0,005) and after two years of treatment was 4,5 mg/m2/month (p=0,045). Complications of treatment occurred in two children: asymptomatic neutropenia and leukopenia.
Conclusions: Levamisole showed a steroid sparing effect and on the reduction of the number of relapses. This effect was more apparent after a longer treatment. After stopping levamisol there was a worsening trend, but with a better evolution than in the year before the start of treatment.
Palavras Chave: steroid-dependent nephrotic syndrome, levamisole