Efficacy and safety of long-term levamisole therapy in maintaining remission in steroid dependent nephrotic syndrome

Abstract

Background: Levamisole (LEV) has been successfully used to maintain remission in steroid dependent nephrotic syndrome (SDNS). When compared to LEV, the costs of other immunosuppressive agents are more than tenfold. There is no uniform agreement on the duration of therapy and most authorities recommend 12 months of LEV. Objective: To assess the efficacy and safety of a 5 year course of LEV in maintaining remission in SDNS in a single centre in Sri Lanka. Method: Children with SDNS attending the nephrotic syndrome clinic at Teaching Hospital Peradeniya who were treated with alternate day LEV 2.5mg/kg from 2004 to 2009 were studied. Children who have previously received immunosuppressive therapy other than prednisolone and LEV and children with renal histology other than minimal change disease were excluded. All patients had full blood counts and liver function tests performed every 3 months to monitor for any potential adverse effects. Results: Of the 186 children studied, in 147 LEV was the final immunosuppressive therapy. LEV was discontinued in 2 children due to gastrointestinal intolerance and in 3 because of a vasculitic rash. Neither neutropenia nor liver dysfunction was a reason for discontinuation of LEV.Conclusions: A 5 year course of LEV was effective and safe in maintaining remission in SDNS.