Single-dose versus multi-dose steroid therapy in pediatric nephrotic syndrome: a systematic review and meta-analysis.
Candela Romano, Lisyareli Salazar Arriaga, Linda Estefania Cordero Velez et al.
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In 30 seconds
This systematic review and meta-analysis compared once-daily with divided-dose prednisolone in children with steroid-sensitive nephrotic syndrome. It included three randomized controlled trials and one non-randomized study, with 288 patients overall. Remission rates were comparable between regimens. In one relapse-setting trial, divided dosing shortened time to remission by 1-2 days, without differences in relapse frequency or safety. For first-episode disease, once-daily dosing was associated with less hypothalamic-pituitary-adrenal axis suppression and a longer time to first relapse. The evidence did not establish superiority of either schedule.
Key findings
- Overall remission rates were comparable with once-daily and divided-dose prednisolone.
- In one relapse-setting trial, split dosing shortened remission by 1-2 days, with no difference in relapse frequency or safety.
- In first-episode disease, once-daily dosing was associated with less HPA-axis suppression and a longer time to first relapse.
- Adverse event profiles were similar across dosing regimens.
Why it matters
The findings suggest that dosing frequency may not materially change overall remission efficacy in children with SSNS, while possible differences in remission speed and HPA-axis suppression vary by disease setting. These trade-offs are relevant when interpreting regimen choices, but the available evidence is too limited to identify a clearly superior schedule.
What to keep in mind
The evidence came from only three randomized trials and one non-randomized study, with small sample sizes and heterogeneous studies; the review states that larger trials with standardized protocols and longer follow-up are needed.