Comparative study of prednisolone and deflazacort in the treatment of initial attack nephrotic syndrome in a tertiary care hospital
DOI:
https://doi.org/10.18203/2349-3291.ijcp20261134Keywords:
Idiopathic nephrotic syndrome, Deflazacort, Prednisolone, Paediatric nephrologyAbstract
Background: Idiopathic nephrotic syndrome is a common chronic kidney disease in children and is conventionally treated with prednisolone. Deflazacort, a synthetic glucocorticoid with comparable anti-inflammatory efficacy and a potentially better safety profile, has emerged as an alternative option.
Methods: This double-blind randomized controlled trial was conducted at Dhaka Medical College Hospital over 12 months. Eighty children aged 2–12 years with first-episode idiopathic nephrotic syndrome were randomly assigned to receive deflazacort (n=41) or prednisolone (n=39) according to standard treatment protocols and were followed for six months. Primary outcomes included time to remission, duration of remission, and relapse rate. Secondary outcomes included growth parameters, blood pressure, biochemical profile, and steroid-related adverse effects.
Results: Baseline demographic and clinical characteristics were comparable between the two groups. Children treated with deflazacort achieved significantly faster remission (6.7±2.8 vs 8.4±2.1 days; p=0.005), longer remission duration (154.3±19.7 vs 120.2±36.1 days; p<0.001), and fewer frequent relapses (≥2 relapses: 12.2% vs 41.1%; p=0.027). Prednisolone was associated with higher rates of hypertension and hypertrichosis and significantly higher follow-up blood pressure. Serum cholesterol levels declined in both groups, with a greater reduction observed in the deflazacort group, while random blood glucose levels remained comparable.
Conclusions: Deflazacort demonstrated superior efficacy and a more favorable adverse-effect profile compared with prednisolone, supporting its use as preferable first-line corticosteroid in children with idiopathic nephrotic syndrome.
References
Nanjundaswamy HM, Phadke KD. Steroid sensitive nephrotic syndrome. The Indian Journal of Pediatrics. 2002 Dec;69(12):1059-63.
Rahman MH, Jesmin T, Muinuddin G. An update of Management of idiopathic nephrotic syndrome: a review article. Bangladesh Journal of Child Health. 2013 Dec 4;37(2):102-21.
Chanchlani R, Parekh RS. Ethnic differences in childhood nephrotic syndrome. Frontiers in pediatrics. 2016 Apr 19;4:39.
Wang CS, Yan J, Palmer R, Bost J, Wolf MF, Greenbaum LA. Childhood nephrotic syndrome management and outcome: a single center retrospective analysis. International Journal of Nephrology. 2017;2017(1):2029583.
Alam MK, Hossain D, Khan AH, Yasmeen BN, Alam MU, Afroz S, Quader MU, Hasan AS, Talukder SA. Renal Histopathology in Childhood Nephrotic Syndrome at National Institute of Kidney Diseases and Urology, Dhaka, Bangladesh an experience of one decade. Northern International Medical College Journal. 2016;8(1):165-9.
Downie ML, Gallibois C, Parekh RS, Noone DG. Nephrotic syndrome in infants and children: pathophysiology and management. Paediatrics and international child health. 2017 Oct 2;37(4):248-58.
Neves C, Cordinhã AC, Ferreira C, Gomes C, Correia AJ. Idiopathic nephrotic syndrome-Deflazacort, an alternative?.
Singhal R, Pandit S, Dhawan N. Deflazacort versus Prednisolone: randomized controlled trial in treatment of children with idiopathic nephrotic syndrome. Iranian Journal of Pediatrics. 2015 Apr 18;25(2):e510.
Parente L. Deflazacort: therapeutic index, relative potency and equivalent doses versus other corticosteroids. BMC Pharmacology and Toxicology. 2017 Jan 5;18(1):1.
Joshi N, Rajeshwari K. Deflazacort. Journal of Postgraduate Medicine. 2009 Oct 1;55(4):296-300.
Lippuner K, Casez JP, Horber FF, Jaeger P. Effects of deflazacort versus prednisone on bone mass, body composition, and lipid profile: a randomized, double blind study in kidney transplant patients. The Journal of Clinical Endocrinology & Metabolism. 1998 Nov 1;83(11):3795-802.
Broyer M, Terzi F, Lehnert A, Gagnadoux MF, Guest G, Niaudet P. A controlled study of deflazacort in the treatment of idiopathic nephrotic syndrome. Pediatric Nephrology. 1997 Jul;11(4):418-22.
Scudeletti M, Piccardo C, Piovano P, Imbimbo B. Effects of a new heterocyclic glucocorticoid, deflazacort (DFC), on the functions of lymphocytes from patients with rheumatoid arthritis (RA). International journal of immunopharmacology. 1987 Jan 1;9(2):133-9.
Ravish Singhal RS, Sadbhavna Pandit SP, Neeraj Dhawan ND. Deflazacort versus prednisolone: randomized controlled trial in treatment of children with idiopathic nephrotic syndrome.
Neves C, Cordinhã AC, Ferreira C, Gomes C, Correia AJ. Idiopathic nephrotic syndrome-Deflazacort, an alternative?.
Park IS, Lee YC, Park HJ, Kim TI, Lee SI, Kim H, Chung KS, Lee-Kim YC. Helicobacter pylori infection in Korea. Yonsei medical journal. 2001 Aug 1;42(4):457-70.
Parente L. Deflazacort: therapeutic index, relative potency and equivalent doses versus other corticosteroids. BMC Pharmacology and Toxicology. 2017 Jan 5;18(1):1.
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