Table 4. Advantages and disadvantages of corticosteroid-sparing agents as first agent for use in FR or SD SSNS.

Agent	Advantages	Disadvantages
Cyclophosphamide	Prolonged remission off therapy Inexpensive	Less effective in SD SSNS Monitoring of blood count during therapy Potential serious short- and long-term adverse effects Only one course should be given
Chlorambucil	Prolonged remission off therapy Inexpensive	Less effective in SD SSNS Monitoring of blood count during therapy Potential serious adverse effects Only one course should be given Not approved for SSNS in some countries
Levamisole	Few adverse effects Generally inexpensive	Continued treatment required to maintain remission Limited availability Not approved for SSNS in some countries
Cyclosporine	Prolonged remissions in some children with SD SSNS	Continued treatment often required to maintain remission Expensive Nephrotoxic Cosmetic side-effects
Tacrolimus	Prolonged remissions in some children with SD SSNS	Continued treatment often required to maintain remission Expensive Nephrotoxic Risk of diabetes mellitus Not approved for SSNS in some countries
Mycophenolate mofetil	Prolonged remissions in some children with FR and SD SSNS Few adverse effects	Continued treatment often required to maintain remission Probably less effective than CNIs Expensive Not approved for SSNS in some countries

FR, frequently relapsing; SD, steroid-dependent; SSNS, steroid-sensitive nephrotic syndrome.