{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T14:42:43Z","timestamp":1787064163554,"version":"build-2736575974"},"reference-count":8,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2017,6,1]],"date-time":"2017-06-01T00:00:00Z","timestamp":1496275200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2016,12,18]],"date-time":"2016-12-18T00:00:00Z","timestamp":1482019200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2017,6]]},"abstract":"\n Background and objectives:<\/jats:title>\n To assess the efficacy and safety of second line drugs used at our center in frequently relapsing and steroid dependant (FR\/SD) childhood nephrotic syndrome.<\/jats:p>\n <\/jats:sec>\n \n Patients and methods:<\/jats:title>\n This was a retrospective study over a period of 3 years (July 2012 to July 2015) on the use of 4 second line drugs in FR\/SD nephrotic syndrome in children treated at our center. These drugs were Levamisole, Mycophenolate Mofetil (MMF), Cyclophosphamide, and Cyclosporine. We studied the relapse rate per year, cumulative dose of steroids, success, failure, and side effects of these drugs. Statistical analyses were done with the help of a statistician using the T-test and the \"N-1\u201dChi\u2013Square test.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n We reviewed the charts of 60 children. All had FR\/SD nephrotic syndrome and received a 3 month protocol of prednisolone. 20 received Levamisole (33%), 12 received Cyclophosphamide (20%), 20 received MMF (25%), and 13 received Cyclosporine (22%).<\/jats:p>\n \n All the four drugs significantly reduced the relapse rate and the cumulative dose of steroids (\n P<\/jats:italic>\n < .0001). Treatment success was best with Cyclosporine (69.2%), and treatment failure was the least with Cyclosporine (7.6%). However, treatment success and failure with Cyclosporine when compared to other three drugs was not statistically significant. No dangerous side effects were seen with any of the 4 drugs in the observation period.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n All the second line drugs in our study were equally effective. However, we recommend that the initial treatment of FR\/SD nephrotic syndrome should be chosen with the least toxic yet equally efficacious drug Levamisole.<\/jats:p>\n <\/jats:sec>","DOI":"10.1016\/j.ijpam.2017.03.002","type":"journal-article","created":{"date-parts":[[2017,3,22]],"date-time":"2017-03-22T05:48:34Z","timestamp":1490161714000},"page":"66-70","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":8,"title":["Experience with second line drugs in frequently relapsing and steroid dependent childhood nephrotic syndrome in a large Saudi center"],"prefix":"10.4103","volume":"4","author":[{"given":"Khalid","family":"Alsaran","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirza","family":"Khalid","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulhadi","family":"Al-Talhi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esam","family":"Al-Kanani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R2-4-20240319","first-page":"35","article-title":"Spontaneous remissions in frequently relapsing and steroid dependant idiopathic nephrotic syndrome","volume":"23","author":"Wingen","year":"1985","journal-title":"Clin Nephrol"},{"key":"R3-4-20240319","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1542\/peds.2008-1559","article-title":"Management of childhood onset nephrotic syndrome","volume":"124","author":"Gipson","year":"2009","journal-title":"Pediatrics"},{"key":"R4-4-20240319","doi-asserted-by":"crossref","first-page":"3661","DOI":"10.1002\/sim.2832","article-title":"Chi-squared and Fischer-Irwin tests of two-by-two tables with small sample recommendations","volume":"26","author":"Campbell","year":"2007","journal-title":"Stat Med"},{"key":"R5-4-20240319","doi-asserted-by":"crossref","first-page":"890","DOI":"10.1002\/sim.4116","article-title":"The analyses of 2X2 contingency tables- yet again","volume":"30","author":"Richard Son","year":"2011","journal-title":"Stat Med"},{"key":"R7-4-20240319","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1007\/s00467-005-2080-9","article-title":"Experience with Levamisole in frequently relapsing and steroid dependant nephroic syndrome","volume":"21","author":"Khalid","year":"2006","journal-title":"Pediatr Nephrol Feb"},{"key":"R8-4-20240319","first-page":"296","article-title":"Nematollah Effect of Levamisole in steroid dependant nephrotic syndrome","volume":"4","author":"Madani","year":"2010","journal-title":"Am J Kidney Dis"},{"key":"R9-4-20240319","first-page":"289","article-title":"Levamisole vs. Cyclophosphamide for frequent-relapsing steroid-dependent nephrotic syndrome","volume":"54","author":"Khalid","year":"2001","journal-title":"Clin Nephrol"},{"key":"R11-4-20240319","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.2215\/CJN.00550206","article-title":"Mycophenolate mofetil in children with frequently relapsing nephrotic syndrome: a report from the Southwest Pediatric Nephrology Study Group","volume":"1","author":"Hogg Ronald","year":"2006","journal-title":"Clin J Am Soc Nephrol CJASN November"}],"container-title":["International Journal of Pediatrics and Adolescent 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