EPIDEMIOLOGY OF STEROID SPARING AGENTS IN CHILDHOOD NEPHROTIC SYNDROME
Dr Chad Maidment1, Dr Anna Francis1
1Queensland Children’s Hospital, South Brisbane, Australia
Aim: We sought to investigate the use and responses of steroid sparing agents in children with frequently relapsing (FRNS) or steroid dependent disease (SDNS) within our single centre Children’s Hospital.
Background: Compared to those who have an infrequently relapsing disease course (IRNS), children with FRNS and SDNS have a higher steroid burden. While Prednisolone (PDN) remains the mainstay of therapy to induce remission, several second line agents are utilised to reduce steroid side effects.
Methods: This retrospective cohort study reviewed electronic medical records to assess the epidemiology and outcomes of children linked to the Queensland Children’s Hospital from November 2014 to July 2023. Outcomes including clinical response (defined as clinician acknowledgement or a reduction in relapses by >50%), adverse events, and duration of therapy were collected.
Results: There were 124 children included in analysis, (71% male, mean age at onset NS 4.8 years, mean age at first contact with Nephrology 6.6 years). The most common initial disease phenotype on first contact with Nephrology was SDNS (44% of the cohort). The steroid sparing agent most often used first was levamisole (54% of first line agents) and the agent with the most positive responses were calcineurin-inhibitors (88% positive clinical response). Adverse event rates were low across the cohort.
Conclusions: While most steroid-sparing agents had an overall positive response no statistically significant variation was observed between initial disease phenotypes. These medications were well tolerated, with few adverse events. Further research is needed to ascertain the best steroid-sparing agent for different disease phenotypes.
Biography:
Chad is a General Paediatrician from the Gold Coast, who recently completed a year as the Renal Fellow at Queensland Children’s Hospital. He has a special interest in glomerular diseases and expanding Nephrology knowledge amongst Paediatricians and Paediatric Trainees.