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Review
. 2023 Jan-Feb;55(1):43-52.
doi: 10.4103/ijp.ijp_673_21.

Efficacy and safety of levamisole in childhood nephrotic syndrome: A meta-analysis

Girish Chandra Bhatt  1 , Bhupeshwari Patel  1 , Rashmi Ranjan Das  2 , Shikha Malik  1 , Martin Bitzan  3 , Nihar Ranjan Mishra  4
Affiliations
Review

Efficacy and safety of levamisole in childhood nephrotic syndrome: A meta-analysis

Girish Chandra Bhatt et al. Indian J Pharmacol. 2023 Jan-Feb.

Abstract

Present evidence regarding the efficacy and safety of levamisole in childhood nephrotic syndrome (NS), particularly the steroid-sensitive NS (SSNS), is limited. We searched relevant databases such as PubMed/MEDLINE, Embase, Google Scholar, and Cochrane CENTRAL till June 30, 2020. We included 12 studies for evidence synthesis (5 were clinical trials that included 326 children). The proportion of children without relapses at 6-12 months was higher in the levamisole group as compared to steroids (relative risk [RR]: 5.9 [95% Confidence interval (CI): 0.13-264.8], I2 = 85%). Levamisole as compared to the control increased the proportion of children without relapses at 6-12 months (RR: 3.55 [95% CI: 2.19-5.75], I2 = 0%). The GRADE evidence was of "very-low certainty" except for the comparison of levamisole with control, the latter being of "moderate certainty." To conclude, levamisole given to children with SSNS is beneficial in preventing relapses and achieving remission as compared to placebo or low-dose steroids. Good-quality trials are needed to provide a robust evidence in this regard. PROSPERO Registration number: CRD42018086247.

Keywords: Evidence-based medicine; levamisole; nephrotic syndrome; systematic review.

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Conflict of interest statement

None

Figures

Figure 1
Figure 1
PRISMA flow diagram. PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses
Figure 2
Figure 2
Summary of the risk of bias assessment
Figure 3
Figure 3
Proportions of SDND/FRNS children without relapses at 6–12 months (levamisole vs. steroids/placebo or no treatment). SDNS = Steroid-dependent nephrotic syndrome, FRNS = Frequent relapse nephrotic syndrome
Figure 4
Figure 4
Adverse events in SDNS/FRNS children receiving levamisole versus steroids/placebo or no treatment, SDNS = Steroid-dependent nephrotic syndrome, FRNS = Frequent relapse nephrotic syndrome
Figure 5
Figure 5
Adverse events in SDNS children receiving levamisole versus cyclophosphamide. SDNS = Steroid-dependent nephrotic syndrome
See this image and copyright information in PMC

References

    1. Hodson EM, Wong SC, Willis NS, Craig JC. Interventions for idiopathic steroid-resistant nephrotic syndrome in children. Cochrane Database Syst Rev. 2016;10:CD003594. - PMC - PubMed
    1. Franke I, Aydin M, Llamas Lopez CE, Kurylowicz L, Ganschow R, Lentze M, et al. The incidence of the nephrotic syndrome in childhood in Germany. Clin Exp Nephrol. 2018;22:126–32. - PubMed
    1. Niaudet P. Long-term outcome of children with steroid-sensitive idiopathic nephrotic syndrome. Clin J Am Soc Nephrol. 2009;4:1547–8. - PubMed
    1. Dehoux L, Hogan J, Dossier C, Fila M, Niel O, Maisin A, et al. Mycophenolate mofetil in steroid-dependent idiopathic nephrotic syndrome. Pediatr Nephrol. 2016;31:2095–101. - PubMed
    1. Iijima K, Sako M, Kamei K, Nozu K. Rituximab in steroid-sensitive nephrotic syndrome: Lessons from clinical trials. Pediatr Nephrol. 2018;33:1449–55. - PMC - PubMed

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