Immunosuppressive treatment for primary membranous nephropathy in adults with nephrotic syndrome

CONCLUSIONS: This updated review strengthened the evidence that immunosuppressive therapy is probably superior to non-immunosuppressive therapy in inducing remission and reducing the number of patients that progress to ESKD. However, these benefits need to be balanced against the side effects of immunosuppressive drugs. The number of included studies with high-quality design was relatively small and most studies did not have adequate follow-up. Clinicians should inform their patients of the lack of high-quality evidence. An alkylating agent (cyclophosphamide or chlorambucil) combined with a corticosteroid regimen had short- and long-term benefits, but this was associated with a higher rate of adverse events. CNI (tacrolimus and cyclosporin) showed equivalency with alkylating agents however, the certainty of this evidence remains low. Novel immunosuppressive treatments with the biologic rituximab or use of adrenocorticotropic hormone require further investigation and validation in large and high-quality RCTs.PMID:34778952 | DOI:10.1002/14651858.CD004293.pub4

Source: Cochrane Database of Systematic Reviews - November 15, 2021 Category: General Medicine Authors: Thilo C von Groote Gabrielle Williams Eric H Au Yizhi Chen Anna T Mathew Elisabeth M Hodson David J Tunnicliffe Source Type: research