Article
Corticosteroid therapy in nephrotic syndrome: a meta-analysis of
randomised controlled trials
Elisabeth M Hodsona, John F Knighta, Narelle S Willisa, Jonathan C Craiga b
a Centre
for Kidney Research, Royal Alexandra Hospital for Children, PO Box
3515, Parramatta, Sydney, NSW 2124, Australia, b Department of Public Health and Community
Medicine, University of Sydney, Sydney, Australia
Correspondence to: Dr Hodson email: Elisah{at}nch.edu.au
Accepted 27 March 2000
AIMS
To determine the benefits and
toxicity of different corticosteroid regimes in preventing relapse in
steroid responsive nephrotic syndrome.
DESIGNMeta-analysis of randomised
controlled trials.
SUBJECTSTwelve trials involving
868 children aged 3 months to 18 years.
MAIN OUTCOME MEASUREFrequency of relapse.
RESULTSA meta-analysis of five
trials, which compared two months of prednisone with three months or
more in the first episode, showed that the longer duration
significantly reduced the risk of relapse at 12-24 months (relative
risk 0.73; 95% confidence interval 0.60 to 0.89) without an increase
in adverse events. There was an inverse linear relation (relative risk
1.382 (SE 0.215) 
0.133 (SE 0.048) duration;
r2 = 0.66; p = 0.05) between
the duration of treatment and risk of relapse.
CONCLUSIONSChildren in their first
episode of steroid responsive nephrotic syndrome should be treated with
prednisone for at least three months, with an increase in benefit being
shown for up to seven months of treatment.
Keywords: nephrotic syndrome; corticosteroid therapy; systematic review; meta-analysis
© 2000 by Archives of Disease in Childhood
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