Immunosuppressive agents for treating IgA nephropathy

Joshua A Samuels; Giovanni FM Strippoli; Jonathan C Craig; Francesco Paolo Schena; Donald A Molony

doi:10.1002/14651858.CD003965

Scolaris Content Display Scolaris Content Display

Contenido relacionado

Ir a:

Revisiones y protocolos relacionados
Respuestas clínicas Cochrane
Guías
Temas

Revisiones y protocolos relacionados

Respuestas clínicas Cochrane

Topics

Temas

Figure 1

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.1

Comparison 1 STEROIDS vs no treatment or placebo or other non immunosuppressive treatment (dypiridamole), Outcome 1 ESRD.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.2

Comparison 1 STEROIDS vs no treatment or placebo or other non immunosuppressive treatment (dypiridamole), Outcome 2 Doubling of serum creatinine.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.3

Comparison 1 STEROIDS vs no treatment or placebo or other non immunosuppressive treatment (dypiridamole), Outcome 3 Remission of proteinuria.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.4

Comparison 1 STEROIDS vs no treatment or placebo or other non immunosuppressive treatment (dypiridamole), Outcome 4 Urinary protein excretion (g/24) at end of treatment.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.5

Comparison 1 STEROIDS vs no treatment or placebo or other non immunosuppressive treatment (dypiridamole), Outcome 5 Serum creatinine (micromoL/L) at end of treatment.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.6

Comparison 1 STEROIDS vs no treatment or placebo or other non immunosuppressive treatment (dypiridamole), Outcome 6 GFR (any measure) at end of treatment.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.1

Comparison 2 CYTOTOXIC agents WITH STEROIDS vs no treatment or placebo, Outcome 1 ESRD.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.2

Comparison 2 CYTOTOXIC agents WITH STEROIDS vs no treatment or placebo, Outcome 2 Urinary protein excretion (g/24 h) at end of treatment.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.3

Comparison 2 CYTOTOXIC agents WITH STEROIDS vs no treatment or placebo, Outcome 3 GFR (any measure) at end of treatment.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.1

Comparison 3 CYTOTOXIC agents or CYCLOSPORINE (NO STEROIDS) vs no treatment or placebo, Outcome 1 ESRD.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.2

Comparison 3 CYTOTOXIC agents or CYCLOSPORINE (NO STEROIDS) vs no treatment or placebo, Outcome 2 Urinary protein excretion (g/24 h) at end of treatment.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.3

Comparison 3 CYTOTOXIC agents or CYCLOSPORINE (NO STEROIDS) vs no treatment or placebo, Outcome 3 Serum creatinine (micromoL/L) at end of treatment.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.4

Comparison 3 CYTOTOXIC agents or CYCLOSPORINE (NO STEROIDS) vs no treatment or placebo, Outcome 4 GFR (any measure) at end of treatment.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Table 1. Electronic search strategies

Database searched	Search strategy
MEDLINE (1966 ‐ September 2002)	1. RANDOMISED CONTROLLED TRIAL[pt] 2. CONTROLLED CLINICAL TRIAL.[pt] 3. RANDOMIZED CONTROLLED TRIALS[mh] 4. RANDOM ALLOCATION[mh] 5. DOUBLE BLIND METHOD[mh] 6. SINGLE BLIND METHOD[mh] 7. 1 or 2 or 3 or 4 or 5 or 6 8. (ANIMAL[mh] NOT (animal[mh] AND human[mh]) 9. 7 not 8 10. CLINICAL TRIAL[pt] 11. CLINICAL TRIALS[mh] 12. Clinical[tw] AND trials[tw] 13. PLACEBOS[mh] 14. placebo[tw] 15. random[tw] 16. RESEARCH DESIGN[mh] 17. 10 or 11 or 12 or 13 or 14 or 15 or 16 18. 17 not 8 19. 18 or 9 20. glomerulonephritis,iga[mh] 21. glomerulonephritis[mh] AND immunology[sh] 22. iga[mh] AND immunology[sh] 23. iga nephropathy[tw] 24. berger disease[tw] 25. 20 or 21 or 22 or 23 or 24 26. 19 and 25
EMBASE (1980 ‐ September 2002)	1. exp Immunoglobulin a Nephropathy/ 2. iga nephropathy.tw. 3. berger$ disease.tw. 4. glomerulonephritis, iga.tw. 5. 1 or 2 or 3 or 4 6. exp clinical trial/ 7. evidence based medicine/ 8. outcomes research/ 9. crossover procedure/ 10. double blind procedure/ 11. single blind procedure/ 12. prospective study/ 13. major clinical study/ 14. exp comparative study/ 15. placebo/ 16. "evaluation and follow up"/ 17. follow up/ 18. randomisation/ 19. or/6‐18 20. controlled study/ not case control study/ 21. or/19‐20 22. (clinic$ adj5 trial$).ti,ab. 23. ((singl$ or doubl$ or trebl$ or tripl$) adj (blind$ or mask$)).ti,ab. 24. (control$ or prospectiv$ or volunteer$).ti,ab. 25. random$.ti,ab. 26. placebo$.ti,ab. 27. or/22‐26 28. 21 or 27 29. limit 28 to human 30. 5 and 29 31. exp clinical trial/ 32. comparative study/ 33. drug comparison/ 34. major clinical study/ 35. randomisation/ 36. crossover procedure/ 37. double blind procedure/ 38. single blind procedure/ 39. placebo/ 40. prospective study/ 41. ((clinical or controlled or comparative or placebo or prospective or randomi#ed) adj3 (trial or study)).ti,ab. 42. (random$ adj7 (allocat$ or allot$ or assign$ or basis$ or divid$ or order$)).ti,ab. 43. ((singl$ or doubl$ or trebl$ or tripl$) adj7 (blind$ or mask$)).ti,ab. 44. (cross?over$ or (cross adj1 over$)).ti,ab. 45. ((allocat$ or allot$ or assign$ or divid$) adj3 (condition$ or experiment$ or intervention$ or treatment$ or therap$ or control$ or group$)).ti,ab. 46. or/31‐40 47. or/41‐45 48. 46 or 47 49. 5 and 48
CENTRAL (Issue 3, 2002)	1. GLOMERULONEPHRITIS‐IGA*:ME 2. (BERGER next DISEASE) 3. (BERGERS next DISEASE) 4. (IGA next NEPHROPATHY) 5. (IGA and NEPHROPATHY) 6. 1 or 2 or 3 or 4 or 5

Table 1. Electronic search strategies

Ir a la tabla de la revisión

Table 2. Quality of randomised trials included in this review

Study ID	Allocation concealment	Blinding	Intention‐to‐treat	Lost to follow‐up %
Julian 1993	Unclear	No	No	2/35 (5.7)
Katafuchi 2003	Unclear	No	No	13/90 (14.4)
Kobayashi 1996	Inadequate	No	No	44/90 (49)
Lai 1986	Unclear	No	No	0/34 (0)
Pozzi 1999	Unclear	No	Yes	3/86 (3.5)
Shoji 2000	Unclear	No	No	2/21 (9)
Welch 1992	Unclear	Participants, Investigators	Unelar	3/20 (15)
Ballardie 2002	Unclear	Outcome assessors	Yes	0/30 (0)
Harmankaya 2002	Unclear	No	No	0/43 (0)
Yoshikawa 1999	Unclear	No	Unclear	4/78 (5.1)
Lai 1987	Unclear	Participants	Yes	0/22 (0)
Walker 1990	Unclear	No	Yes	1/52 (1.9)
Woo 1987	Unclear	No	Yes	0/48 (0)

Table 2. Quality of randomised trials included in this review

Ir a la tabla de la revisión

Table 3. Categories of interventions used in individual trials and duration of follow‐up

Study ID	Treatment	Control	Follow‐up duration
Julian 1993	Steroids	No treatment	6‐24 mths
Katafuchi 2003	Steroids + dipyridamole	Dipyridamole	60 mths
Kobayashi 1996	Steroids	No treatment	120 mths
Lai 1986	Steroids	No treatment	38 mths
Pozzi 1999	Steroids	No treatment	60 mths
Shoji 2000	Steroids	Anticoagulants	13.4 mths
Welch 1992	Steroids	Placebo	3 mths
Ballardie 2002	Steroids + cyclophosphamide	No treatment	24‐72 mths
Harmankaya 2002	Steroids + azathioprine	No treatment	60 mths
Yoshikawa 1999	Steroids + azathioprine +anticoagulants	Anticoagulants	24 mths
Lai 1987	Cyclosporin	Placebo	3 mths
Walker 1990	Cyclophosphamide + anticoagulants	Anticoagulants	23 mths
Woo 1987	Cyclophosphamide + anticoagulants	no treatment	36 mths

Table 3. Categories of interventions used in individual trials and duration of follow‐up

Ir a la tabla de la revisión

Table 4. Reports of adverse events in individual trials

Study ID	Intervention	Reported side effect	n in Rx group	N in Rx group	n in control group	N in control group
Julian 1993	Steroids vs no treatment	Overt diabetes, insomnia, acne	2+2+3	18	1	17
Katafuchi 2003	Steroids+dypiridamole vs dypiridamole	Palpitations, insomnia	3	43	1	47
Kobayashi 1996	Steroids vs no treatment	None reported	0	20	0	26
Lai 1986	Steroids vs no treatment	Gastritis, hypertension	1+3	17	0+0	17
Pozzi 1999	Steroids vs no treatment	None reported	0	43	0	43
Shoji 2000	Steroids vs dypiridamole	Headache	0	11	1	8
Welch 1992	Steroids vs placebo	None reported	0	20	0	20
Ballardie 2002	Steroids+cyclophosphamide vs no treatment	Pulmonary TBC, overt diabetes, bone marrow toxicity, gastrointestinal toxicity	1+1+1+1+1	19	0+0+0+0+0	19
Harmankaya 2002	Steroids+azathioprine vs no treatment	Increased transaminase levels, minor cushingoid features, gastric pain	1+2+1	21	0	22
Yoshikawa 1999	Steroids+azathioprine+dypiridamole vs dypiridamole	Alopecia, anemia, leukopenia, cataract, ulcer, depression	1+0+3+1+1+1	40	0+1+0+0+0+0	38
Lai 1987	Cyclosporin vs placebo	Dyspepsia, headache, hypertension, hirsutism	6+7+1+3+7	12	0+0+0+0+1	12
Walker 1990	Cyclophosphamide+dypiridamole+warfarin vs no treatment	Gonadal toxicity, headache	2+1	25	0+0	27
Woo 1987	Cyclophosphamide+dypiridamole+warfarin vs no treatment	Gum bleeding	2	27	0	21

Table 4. Reports of adverse events in individual trials

Ir a la tabla de la revisión

Comparison 1. STEROIDS vs no treatment or placebo or other non immunosuppressive treatment (dypiridamole)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 ESRD Show forest plot	6		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

1.1 Steroid vs no treatment or placebo	6	341	Risk Ratio (M‐H, Random, 95% CI)	0.44 [0.25, 0.80]
2 Doubling of serum creatinine Show forest plot	6		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

2.1 Steroid vs no treatment or placebo	6	341	Risk Ratio (M‐H, Random, 95% CI)	0.45 [0.29, 0.69]
3 Remission of proteinuria Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected

3.1 Steroid vs no treatment or placebo	1		Risk Ratio (M‐H, Random, 95% CI)	15.0 [0.92, 243.52]
4 Urinary protein excretion (g/24) at end of treatment Show forest plot	6	263	Mean Difference (IV, Random, 95% CI)	‐0.49 [‐0.72, ‐0.25]

4.1 Steroid vs no treatment or placebo	5	244	Mean Difference (IV, Random, 95% CI)	‐0.58 [‐0.95, ‐0.21]
4.2 Steroid vs dypiridamole	1	19	Mean Difference (IV, Random, 95% CI)	‐0.42 [‐0.72, ‐0.12]
5 Serum creatinine (micromoL/L) at end of treatment Show forest plot	5	173	Mean Difference (IV, Random, 95% CI)	‐23.95 [‐53.71, 5.81]

5.1 Steroid vs no treatment or placebo	4	154	Mean Difference (IV, Random, 95% CI)	‐31.08 [‐63.84, 1.68]
5.2 Steroid vs dypiridamole	1	19	Mean Difference (IV, Random, 95% CI)	0.0 [‐17.62, 17.62]
6 GFR (any measure) at end of treatment Show forest plot	4	138	Mean Difference (IV, Random, 95% CI)	17.87 [4.93, 30.82]

6.1 Steroid vs no treatment or placebo	3	119	Mean Difference (IV, Random, 95% CI)	21.66 [7.87, 35.44]
6.2 Steroid vs dypiridamole	1	19	Mean Difference (IV, Random, 95% CI)	2.5 [‐19.46, 24.46]

Comparison 1. STEROIDS vs no treatment or placebo or other non immunosuppressive treatment (dypiridamole)

Ir a la tabla de la revisión

Comparison 2. CYTOTOXIC agents WITH STEROIDS vs no treatment or placebo

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 ESRD Show forest plot	3		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

1.1 Cytotoxic agents + steroids vs placebo or no treatment or anticoagulants	3	152	Risk Ratio (M‐H, Random, 95% CI)	0.59 [0.06, 6.03]
2 Urinary protein excretion (g/24 h) at end of treatment Show forest plot	3		Mean Difference (IV, Random, 95% CI)	Subtotals only

2.1 Cytotoxic agents vs placebo or no treatment	3	154	Mean Difference (IV, Random, 95% CI)	‐1.25 [‐2.71, 0.21]
3 GFR (any measure) at end of treatment Show forest plot	1		Mean Difference (IV, Random, 95% CI)	Totals not selected

3.1 Cytotoxic agents vs placebo or no treatment	1		Mean Difference (IV, Random, 95% CI)	2.0 [‐15.98, 19.98]

Comparison 2. CYTOTOXIC agents WITH STEROIDS vs no treatment or placebo

Ir a la tabla de la revisión

Comparison 3. CYTOTOXIC agents or CYCLOSPORINE (NO STEROIDS) vs no treatment or placebo

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 ESRD Show forest plot	3	130	Risk Ratio (M‐H, Random, 95% CI)	0.35 [0.04, 3.22]

1.1 Cytotoxic agents vs placebo or no treatment or no cytotoxic agent	2	106	Risk Ratio (M‐H, Random, 95% CI)	0.35 [0.04, 3.22]
1.2 Cyclosporine vs placebo or no treatment	1	24	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
2 Urinary protein excretion (g/24 h) at end of treatment Show forest plot	3	122	Mean Difference (IV, Random, 95% CI)	‐0.94 [‐1.43, ‐0.46]

2.1 Cytotoxic agents vs placebo or no treatment	2	100	Mean Difference (IV, Random, 95% CI)	‐0.74 [‐0.95, ‐0.54]
2.2 Cyclosporine vs placebo or no treatment	1	22	Mean Difference (IV, Random, 95% CI)	‐1.60 [‐2.43, ‐0.77]
3 Serum creatinine (micromoL/L) at end of treatment Show forest plot	3	122	Mean Difference (IV, Random, 95% CI)	‐7.53 [‐33.58, 18.51]

3.1 Cytotoxic agents vs placebo or no treatment	2	100	Mean Difference (IV, Random, 95% CI)	‐21.30 [‐65.09, 22.49]
3.2 Cyclosporine vs placebo or no treatment	1	22	Mean Difference (IV, Random, 95% CI)	0.0 [‐32.39, 32.39]
4 GFR (any measure) at end of treatment Show forest plot	2	70	Mean Difference (IV, Random, 95% CI)	7.94 [‐1.69, 17.57]

4.1 Cytotoxic agents vs placebo or no treatment	1	48	Mean Difference (IV, Random, 95% CI)	14.59 [‐1.89, 31.07]
4.2 Cyclosporine vs placebo or no treatment	1	22	Mean Difference (IV, Random, 95% CI)	4.5 [‐7.36, 16.36]

Comparison 3. CYTOTOXIC agents or CYCLOSPORINE (NO STEROIDS) vs no treatment or placebo

Ir a la tabla de la revisión

The Cochrane Library

Scolaris Language Selector Scolaris Language Selector

Idioma de la Revisión Cochrane

Idioma de la web

Scolaris Content Language Banner Portlet Scolaris Content Language Banner Portlet