Efficacy and Safety of Methylprednisolone Pulse Therapy and Conventional Oral Prednisone for Pediatric Patients With Nephrotic Syndrome.

Abstract

Context: High-dose methylprednisolone pulse therapy and oral high-dose prednisone are two common treatments for pediatric nephrotic syndrome (NS). While both treatments have shown effectiveness for patients with pediatric NS to some extent, a clear comparison of their efficacy and safety remains elusive, posing a challenge for clinicians when devising treatment plans.

Objective: The study intended to compare the efficacy and safety of high-dose methylprednisolone pulse therapy and conventional oral high-dose prednisone for pediatric patients with NS, to provide more accurate treatment recommendations for clinicians to optimize their treatment plans, improve their QoL, and prevent complications.

Design: The research team conducted a randomized controlled trial.

Setting: The study took place at the Second Affiliated Hospital of Fujian Medical University in Quanzhou, China.

Participants: Participants were 60 patients with pediatric NS who received treatment at the hospital between November 2020 and March 2022.

Interventions: The research team randomly divided participants into two groups, each comprising 30 patients: (1) the intervention group, which received high-dose methylprednisolone pulse therapy, and (2) the conventional group, which received oral high-dose prednisone.

Outcome measures: The research team measured: (1) clinical efficacy rates, the primary outcome measure; (2) time to symptom relief; (3) laboratory indicators, including blood urea nitrogen (BUN), serum creatinine (SCr), serum globulin (GLB), and 24-hour urine protein quantification; and (4) incidence of adverse events.

Results: Compared to the conventional group, the intervention group's: (1) clinical efficacy rate was significantly higher (P < .05); (2) resolution times for edema (P < .001) and urine protein turning negative (P < .001) were significantly shorter; (3) levels of BUN (P < .001), SCr (P < .001), GLB (P < .001), and 24-hour urine protein quantification (P < .001) were significantly lower; and (4) incidence of adverse reactions was significantly higher (P < .001).

Conclusions: High-dose methylprednisolone pulse therapy demonstrated better efficacy in treating pediatric NS patients, showing a shorter time to symptom relief, but it may also entail a higher risk of adverse reactions compared to conventional oral high-dose prednisone. Clinicians should consider the specific circumstances and needs of pediatric patients when selecting a treatment.