Long term tapering versus standard prednisolone treatment for first episode of childhood nephrotic syndrome: phase III randomised controlled trial and economic evaluation复制标题

长期减量与标准泼尼松龙治疗儿童肾病综合征首发: III期随机对照试验和经济学评价

The best initial prednisolone regimen for children presenting with steroid sensitive nephrotic syndrome remains unknown. The eight week course first described in the 1960s by the International Study of Kidney Disease in Children (prednisolone 60 mg/m2 for four weeks then 40 mg/m2 on alternate days for four weeks) continues to be used in most UK centres and in many other countries. However, systematic review data suggest that a more intensive initial treatment course improves clinical outcomes. When the prednisolone in nephrotic syndrome (PREDNOS) trial started, six randomised controlled trials had compared the eight week course with a range of different prednisolone regimens of three months or longer. A 2005 Cochrane review concluded that prednisolone treatment of three months or longer statistically significantly reduced the rate of relapse at 12-24 months and the rate of frequently relapsing nephrotic syndrome. The Kidney Disease: Improving Global Outcomes guidelines published in 2012 supported the conclusions of this Cochrane review. These guidelines recommended daily prednisolone treatment of 60 mg/m2 or 2 mg/kg for four to six weeks followed by 40 mg/m2 or 1.5 mg/kg on alternate days and continued for two to five months, with tapering of the dose.

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