Abstract: Objective To compare the clinical efficacy of direct reduction versus gradual tapering regimens of glucocorticoids in patients with nephrotic syndrome. Methods A total of 204 patients with nephrotic syndrome treated at Huai,an Hospital of Huai,an City from January 2022 to January 2025 were enrolled and randomly assigned via a random number table to a direct reduction group (n = 102) or a gradual tapering group (n=102). the direct dose reduction group gradually decreased the dose to 20 mg·d^-1 starting from the 9th week after the initial 8-week treatment period, maintained this dose for 1 week, then continued at 20 mg · d-1 from the 12th week onward. The dose was reduced to 10 mg·d^-1 at the 13th week and maintained for 4 weeks, further reduced to 5 mg·d^-1 at the 17th week and maintained for 12 weeks, followed by discontinuation at the 29th week,the total treatment duration was 28 weeks, with an accumulated dose of approximately 3 640 mg (calculated based on a 60 kg body weight); The gradual tapering group underwent stepwise dose reduction after an initial 8-week treatment (decreasing by 10 mg per week during weeks 9~10, 2.5 mg per week during weeks 13~14, and 1.25 mg per week during weeks 19 ~ 20, maintaining the corresponding doses between reductions).The maintenance dose of 5 mg per day was then administered during weeks 21~28, followed by discontinuation at week 29. The total treatment cycle was 28 weeks, with a cumulative dose of approximately 3 180 mg (calculated based on a body weight of 60 kg). Renal function indicators blood urea nitrogen (BUN), serum creatinine (Scr), 24- hour urinary protein, immune function parameters peripheral blood T lymphocyte subsets (CD3⁺, CD4⁺, CD8⁺) before and after treatment, and the incidence of adverse reactions were compared between the two groups. Results After 28 weeks of treatment, both groups showed significant decreases in BUN, Scr, and 24-hour urinary protein levels, and increases in CD3⁺, CD4⁺, and CD4⁺/CD8⁺ ratio (P ＜ 0.05). Compared with the direct reduction group, the gradual tapering group exhibited more pronounced reductions in BUN, Scr, and 24-hour urinary protein levels, as well as greater increases in CD3⁺, CD4⁺, and CD4⁺/CD8⁺ ratio (P ＜ 0.05). There was no statistically significant difference in the overall incidence of adverse reactions between the two groups (P ＞ 0.05). Conclusion The gradual tapering regimen of glucocorticoids is more effective than the direct reduction regimen in improving renal and immune function in patients with nephrotic syndrome. It may therefore be considered a preferable tapering strategy for these patients.