The Effect of Montelukast Sodium on the Reduction of Relapse Rates in Children with Steroid Dependent Nephrotic Syndrome

Author(s): Abeyagunawardena S, Jayaweera H, Abeyagunawardena AS

Background: Montelukast sodium (MS) a leukotriene receptor antagonist is known to reduce upper respiratory tract infections in children with asthma. A single centre study was conducted in Sri Lanka to evaluate the efficacy of MS in reducing the relapse rate of nephrotic syndrome (NS).

Methods and Findings: Patients with minimal-change disease, who were already on low-dose (<0.6 mg/kg) alternate-day prednisolone for a minimum of 12 months with or without adjuvant therapy were prescribed MS (4 mg for <6 years and 5 mg for >6 years) for 12 months. Urine protein excretion was recorded daily, by parents. Patients were on monthly follow-up, to assess relapse of proteinuria, episodes of infection and side effects of MS. 118 children were prescribed MS and 112 completed the 12 months of therapy. Median age was 6.2 years. Age range was 3.5-14.7 years. 79 were male and 33 were female. Significant reduction (p<0.001) in relapses was observed during MS therapy (mean=2.52 ± SD 0.60) compared to that of the previous year (mean=1.41 ± SD 0.87). The difference of relapse rates before and after the completion of MS therapy (mean=1.72 ± SD1.05) was also significant (p<0.001). The type of adjuvant therapy (Levamisole, Mycophenolate mofetil or cyclosporin A) did not have an impact on relapse rates during MS treatment. No significant side-effects were encountered with MS therapy.

Conclusion: The prescription MS is a potential therapeutic strategy in maintaining remission in childhood NS.