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Abstract: PO1883

Steroid Treatment for the First Episode of Childhood Nephrotic Syndrome: Comparison of the 8- and 12-Week Regimen Using an Individual Patient Data Meta-Analysis

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Schijvens, Anne Merel, Radboudumc, Nijmegen, Gelderland, Netherlands
  • Teeninga, Nynke, Universitair Medisch Centrum Utrecht, Utrecht, Utrecht, Netherlands
  • Dorresteijn, Eiske, Erasmus MC, Rotterdam, Zuid-Holland, Netherlands
  • Webb, Nicholas, Royal Manchester Children's Hospital, Manchester, Manchester, United Kingdom
  • Schreuder, Michiel F., Radboudumc, Nijmegen, Gelderland, Netherlands
Background

Steroids are the cornerstone of the treatment of childhood nephrotic syndrome. The optimal duration for the first episode remains a matter of debate. The aim of this study is to determine whether the 8 weeks ISKDC regimen (prednisolone 4 weeks 60mg/m2 daily, 4 weeks 40mg/m2 on alternate days) is equally effective as the 12 weeks APN regimen (prednisolone 6 weeks 60mg/m2 daily, 6 weeks 40mg/m2 on alternate days).

Methods

An individual patient data (IPD) meta-analysis of randomized controlled trials reporting on prednisolone treatment for a first episode of childhood nephrotic syndrome was conducted. European trials aimed at investigating the ISKDC and/or APN steroid regimen were selected. Statistical models were adjusted for relevant covariates.

Results

Four trials included European patient cohorts treated according to the ISKDC and/or APN steroid regimen. IPD of two trials were available (PREDNOS, UK, 2019, n=109 and Nephrotic Syndrome trial, the Netherlands, 2013, n=62). Baseline characteristics did not significantly differ between the two treatment groups, with the exception of ethnicity. A significant difference was found in the time to first relapse after cessation of steroid treatment between the 8 and 12 weeks treatment group (p 0.04). The incidence of frequent relapsing nephrotic syndrome (FRNS) was similar in the two groups (p 0.75). Interestingly, a significant difference was found in the incidence of steroid dependent nephrotic syndrome (44% [8 weeks] vs 24% [12 weeks], p 0.01). Overall, relapse rate ratios were 51% higher in the 8 weeks group compared to the 12 weeks group (p 0.01). Finally, children below 4 years of age seem to have a significantly lower survival time (time to first relapse and time to FRNS) compared to children of 4 years and older (p 0.02 and p 0.003).

Conclusion

The results of this IPD meta-analysis suggest that the 8 weeks regimen for a first episode of nephrotic syndrome is not equally effective as the 12 weeks steroid regimen. Although less steroids for the first episode would be beneficial in terms of steroid toxicity in the short term, these results suggest patients treated with a 12 week steroid regimen may have a less complicated disease course.

Funding

  • Private Foundation Support