Short and long-term outcome of levamisole in early versus late steroid responsive nephrotic syndrome: A single centre experience

Objectives: To determine the effectiveness of Levamisole (Leva) in maintaining short-term and long-term remission in early steroid responders (ESRs) and late steroid responders (LSRs). Methods: This retrospective study on 106 cohorts, aged 2-14 years with frequent-relapsing (FR) and steroid-dependent nephrotic syndrome (SDNS) who received Leva over 10-years (2012-2023), was carried out at tertiary care centre, Karachi from January-August 2023. Patients were categorized based on steroid response during first episode of NS as ESRs if complete remission (CR) was achieved within two weeks of daily steroid and LSRs if CR achieved between two-four weeks. Leva was administered after inducing remission with daily steroid after labelling as FRNS and SDNS. Low-dose steroid was continued during Leva-therapy. Short-term outcome was assessed at completion of Leva and long-term outcome in terms of CR, relapse frequency, alternative immunosuppressive agents (ISAs) use and compliance was assessed at six, 12 and 36-months' follow-up while off levamisole therapy. Results: Leva was used in 106 patients (male 67%) for 20.4 +/- 8months during the study period. The mean age at Levainitiation was 6.3 +/- 3 years. Eighty-three were FRNS and 23 SDNS. ESRs were 64 and 42 were LSRs. Overall, Leva was effective in maintaining short-term CR (73%) at end of Leva and it was effective in both ESRs (75%) and LSRs (69%, p=0.51) as well as in FRNS (72%) and SDNS (74%), P=0.08). Post-Leva follow-up duration was 36 +/- 31 months. Long-term Leva was effective in both ESRs and LSRs (p=0.51). Complete remission in 22,17 and 26%; infrequent relapses in 50,40 and 5% and alternate ISAs use in 24,39 and 55% at six,12 and 36 months follow-up respectively. Conclusion: Levamisole was effective in maintaining short-term and long-term remission in early and late initial steroid responsive nephrotic syndrome.