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

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.