Efficacy and safety of immunosuppressive medications for steroid-resistant nephrotic syndrome in children: a systematic review and network meta-analysis
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Shaojun Li1,3, Haiping Yang2,5, Pengfei Guo1,3, Xiaoxiao Ao1,4, Junli Wan2,4, Qiu Li1,2,3 and Liping Tan1,4
1Department of Emergency, Children's Hospital of Chongqing Medical University, Chongqing, China
2Department of Nephrology, Children's Hospital of Chongqing Medical University, Chongqing, China
3Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
4Key Laboratory of Pediatrics in Chongqing, Chongqing, China
5Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, China
Liping Tan, email: [email protected]
Keywords: immunosuppressant, SRNS, pediatrics, multiple-treatments meta-analysis
Received: June 21, 2017 Accepted: August 07, 2017 Published: August 21, 2017
Background: Conventional meta-analyses and randomized controlled trials have shown inconsistent results regarding the efficacy of immunosuppressants for pediatric steroid-resistant nephrotic syndrome (SRNS).
Objective: To conduct a network meta-analysis aimed at evaluating the efficacy and safety of available immunosuppressive agents in pediatric patients with SRNS.
Study methods: MEDLINE, the Cochrane Central Register of Controlled Trials, and EMBASE were searched on January 2017. Data from randomized controlled trials (RCTs) were included. The main outcomes analyzed were efficacy [number/portion with complete remission (CR), number/portion with partial remission (PR), and total number/portion in remission (TR)] and safety [adverse secondary event (ASE) rates].
Results: A meta-analysis of 18 RCTs showed that tacrolimus was more efficacious for achieving CR than intravenous (i.v.) cyclophosphamide, mycophenolate mofetil (MMF), oral cyclophosphamide, leflunomide, chlorambucil, azathioprine, and plaebo/nontreatment (P/NT), and more efficacious than i.v. cyclophosphamide, oral cyclophosphamide, and P/NT in terms of TR outcomes. Cyclosporin was associated with a greater CR rate than i.v. cyclophosphamide, MMF, oral cyclophosphamide, chlorambucil, azathioprine, or P/NT, and associated with a greater TR rate than i.v. cyclophosphamide, oral cyclophosphamide, or P/NT. MMF was found to be more efficacious than i.v. cyclophosphamide and oral cyclophosphamide in terms of TR.
Conclusions: Tacrolimus and cyclosporine may be preferred initial treatments for children with SRNS. MMF may be another option for this patient population. Further studies of the efficacy and safety of these three drugs in children with SRNS should be pursued.
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