Comparison of Relapse Rates and Time to Remission with Prednisolone Versus Deflazacort in Children with Idiopathic Nephrotic Syndrome

Background: Idiopathic nephrotic syndrome (INS) is the most common glomerular disorder in children. While corticosteroids remain the cornerstone of treatment, the comparative effectiveness of prednisolone and deflazacort regarding remission time and relapse rates remains a key clinical concern. This study aims to compare the relapse rates and time to remission between prednisolone and deflazacort in children with idiopathic nephrotic syndromeMethods: This randomized controlled trial was conducted at the Department of Pediatric Nephrology, National Institute of Kidney Diseases and Urology (NIKDU), Dhaka, Bangladesh, from June 2019 to January 2021.A total of 74 children aged 2-12 years with an initial episode of idiopathic nephrotic syndrome were randomized into two groups: Group A (n=37) received prednisolone, and Group B (n=37) received deflazacort for 12 weeks.Patients were followed for 6 months to assess time to remission, number of relapses, and side effects. Results:The mean time to remission was significantly shorter in Group B (deflazacort) compared to Group A (prednisolone) (7.87 3.33 days vs. 9.82 3.43 days; p=0.02).After 3 months, relapses occurred in 10.8% of Group A and 2.7% of Group B (p=0.17).At 6 months, relapse rates were 27.0% in Group A and 18.9% in Group B (p=0.41).Cushingoid features and metabolic complications were more frequent in the prednisolone group, though not statistically significant. Conclusion:Deflazacort induced earlier remission with fewer relapses and fewer adverse effects compared to prednisolone, suggesting a favorable alternative in the treatment of pediatric idiopathic nephrotic syndrome.