Is two month initial prednisolone treatment for nephrotic syndrome inferior to longer duration therapy?

This multi-center randomized trial [1] in children with steroid sensitive nephrotic syndrome (NS) compared prednisolone therapy for 2 months versus 6 months. Authors evaluated time to occurrence of frequent relapse, time to first relapse, and various adverse events in 255 children (1-15 years) from 90 Japanese hospitals presenting with first episode of NS. Those who achieved remission within 3 weeks of prednisolone therapy were randomized to either 6 months therapy [60 mg/m2 daily for 4 wk, gradually (4 weekly) tapering alternate day doses for next 24 wk] or 2 months therapy (60 mg/m2 daily for 4 wk, 40 mg/m2 alternate day for 4 wk) with oral prednisolone. Children were followed up for at least 2 years. The authors reported comparable (i) time to frequent relapses (RR 0.86, 95% CI 0.64, 1.16), (ii) episodes of relapse (RR 0.92, 95% CI 0.75, 1.14), (iii) frequent relapses (RR 0.99, 95% CI 0.72, 1.38), (iv) time to first relapse, (v) relapse rate per person-year, and (vi) adverse effects (hypertension, cushingoid facies, glaucoma, and elevated hepatic enzymes). The authors also presented a meta-analysis comparing trials using 2-3 versus 5-6 months therapy, and reported comparable results. They suggested that 2 months of prednisolone is not inferior to 6 months therapy.