A comparison of cyclophosphamide versus tacrolimus in terms of treatment effect for idiopathic membranous nephropathy: A meta-analysis

Li, Yanchun; Huang, Jing; Li, Xin; Zhao, Su Mei

doi:10.1016/j.nefro.2018.10.008

Cited by 6 publications

(6 citation statements)

References 33 publications

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“…The primary outcome measures were completed with partial remission, while the secondary outcomes included suPAR level, side effects, together with renal function during treatment and follow-up. The potential side effects were hemorrhagic cystitis, nocturia, enuresis, amenorrhea, delayed puberty, blood dyscrasia, AKI, and hypertension (8,(46)(47)(48).…”

Section: Outcome Variablesmentioning

confidence: 99%

The Unique Difference Between Serum Level of Soluble Urokinase Plasminogen Activator Receptor (suPAR) in Steroid-Resistant Nephrotic Syndrome Children Treated with an Alkylating Agent and Calcineurin Inhibitors

et al. 2021

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Background: Steroid-resistant nephrotic syndrome (SRNS) is a leading contributor to chronic kidney disease (CKD), and calcineurin inhibitors (CNIs) or monoclonal antibodies are currently the best identified therapy. Meanwhile, some developing countries still use alkylating agents (AA) such as cyclophosphamide (CPA) to treat SRNS due to economic reasons. Objectives: This study aims to determine the employability of soluble urokinase plasminogen activator receptor (suPAR) as a biomarker for monitoring therapy in SRNS children and compare the clinical improvement with those treated with an AA and CNIs. Methods: This was a retrospective cohort study conducted at Hasan Sadikin Hospital, Indonesia. The data was collected from July 2019 to July 2020 from 70 children with FSGS. Clinical signs were evaluated monthly, and serum suPAR level was measured at the third and sixth months following therapy. Two-way repeated measures ANOVA was carried out to compare the differences in suPAR level at baseline with the third and sixth months in SRNS patients who received AA and CNIs. Results: The mean age was nearly similar between the two groups based on the t-test (P = 0.140). Steroid-resistant nephrotic syndrome was more frequent in boys than in girls (P = 0.020), according to the Chi-square test. Baseline serum suPAR level was not significantly different between the two groups. In the third month, the daily urinary protein level was higher in SRNS patients that received the AA compared to the CNIs group (P < 0.001). There was a significant interaction between time and treatment (F(2,138) = 7.203, P = 0.001), with higher suPAR level in SRNS patients that received the AA compared to those administered with CNIs at the 3rd and 6th months, but this difference was not statistically significant (P > 0.05). Conclusions: As a noninvasive tool, suPAR is a promising modality in monitoring SRNS therapy, and CNIs have a tendency to achieve faster remission than the AA.

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Section: Outcome Variablesmentioning

confidence: 99%

The Unique Difference Between Serum Level of Soluble Urokinase Plasminogen Activator Receptor (suPAR) in Steroid-Resistant Nephrotic Syndrome Children Treated with an Alkylating Agent and Calcineurin Inhibitors

et al. 2021

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“…However, corticosteroids still exhibit adverse effects. [ 16 , 17 ] In recent years, some studies have compared TAC monotherapy with CTX combined with corticosteroids for IMN concerning efficacy and safety, and the results are controversial. Our meta-analysis was conducted to compare the efficacy and drug safety between TAC monotherapy with CTX combined with corticosteroids for IMN.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of tacrolimus monotherapy versus cyclophosphamide–corticosteroid combination therapy for idiopathic membranous nephropathy

Gong

et al. 2021

Medicine

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Objective The objective of this meta-analysis was to compare the efficacy and safety of tacrolimus (TAC) monotherapy versus cyclophosphamide (CTX)-corticosteroid combination therapy in idiopathic membranous nephropathy (IMN) patients. Methods Databases including the PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure, and Wanfang databases were searched from inception to October 20, 2020. Eligible studies comparing TAC monotherapy and CTX-corticosteroid combination therapy in IMN patients were included. Data were analyzed using Review Manager Version 5.3. Results Nine studies were included in the meta-analysis. One randomized controlled trial and eight cohort studies involving 442 patients were identified. Compared with CTX-corticosteroid combination therapy for IMN, TAC monotherapy had higher complete remission (CR) at month 6 (odds ratio [OR] 2.18, 95% confidence interval [CI] 1.35–3.50, P < .01). The 2 therapeutic regimens had similar partial remission (OR 0.69, 95% CI 0.45–1.04, P = .08), total remission (OR 1.38, 95% CI 0.85–2.23, P = 0.19) at month 6, and similar CR (OR 1.64, 95% CI 0.84–3.19, P = .15), partial remission (OR 0.71, 95% CI 0.37–1.38, P = 0.31), and total remission (OR 1.29, 95% CI 0.55–3.01, P = .56) after 1 year. The relapse rate of the TAC group was higher than that of the CTX group, but the difference was not statistically significant (OR 1.85, 95% CI 0.75–4.53, P = .18). There was no difference between the 2 therapeutic regimens concerning glucose intolerance (OR 1.15, 95% CI 0.61–2.14, P = .67), acute renal failure (OR 1.14, 95% CI 0.39–3.33, P = .81), or tremors (OR 4.39, 95% CI 0.75–25.67, P = .10). Incidences of gastrointestinal symptoms (OR 0.29, 95% CI 0.10–0.79, P = .02), infection (OR 0.18, 95% CI 0.08–0.39, P < 0.01), leukopenia (OR 0.14, 95% CI 0.04–0.51, P < .01), and abnormal aminotransferase (OR 0.31, 95% CI 0.13–0.77, P = .01) in the TAC group were all lower than those in the CTX group. Subgroup analysis showed that there was no significant difference between the TAC group and the CTX combined with corticosteroid 0.8 to 1 mg/kg/day group concerning CR at month 6 ( P > .05). There was no significant difference between the TAC group and the CTX combined with corticosteroid 0.5 mg/kg/day group concerning abnormal aminotransferase ( P > .05). Conclusion TAC monotherapy is comparable to CTX-corticosteroid combination therapy for renal remission in IMN patients. TAC monotherapy had a higher CR in the early st...

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“…[ 7 , 8 ] Some meta-analyses showed that TAC combined with corticosteroids also had a satisfactory effect on IMN compared with CTX combined with corticosteroids. [ 9 , 10 ] However, corticosteroids still exhibited adverse effects. In recent years, some studies have compared TAC monotherapy with TAC combined with corticosteroids for IMN concerning efficacy and safety, and the results were controversial.…”

Section: Introductionmentioning

confidence: 99%

“…Compared to cyclosporine, TAC showed a stronger immunosuppressive effect and fewer side effects [7,8] . Some meta-analyses showed that TAC combined with corticosteroids also had a satisfactory effect on IMN compared with CTX combined with corticosteroids [9,10] . However, corticosteroids still exhibited adverse effects.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of tacrolimus monotherapy versus tacrolimus-corticosteroid combination therapy for idiopathic membranous nephropathy

Gong

et al. 2021

Medicine

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Objective: The objective of this meta-analysis was to compare the efficacy and safety of tacrolimus (TAC) monotherapy versus TAC-corticosteroid combination therapy in idiopathic membranous nephropathy (IMN) patients. Methods: Databases including PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure, and Wanfang database were searched from inception to January 10, 2021. Eligible studies comparing TAC monotherapy and TAC-corticosteroid combination therapy in IMN patients were included. Data were analysed using Review Manager Version 5.3. Results: Seven studies were included in the meta-analysis. One randomized controlled trial and six cohort studies involving 372 patients were identified. Compared with TAC monotherapy, TAC-corticosteroid had a higher total remission at the sixth month (odd ratio (OR) 0.49, 95% confidence interval (CI) 0.31–0.78, P < .01). The two therapy regimens had similar complete remission rates (OR 0.79, 95% CI 0.43–1.48, P = .47) at the sixth month and similar relapse rates (OR 1.44, 95% CI 0.70–2.92, P = .32). TAC-corticosteroid combination therapy had a higher incidence of infection (OR 0.38, 95% CI 0.18–0.81, P = .01). The two therapy regimens had similar incidences of gastrointestinal symptoms (OR 0.96, 95% CI 0.34–2.70, P = .93), abnormal aminotransferase (OR 0.90, 95% CI 0.34–2.38, P = .84), and glucose intolerance (OR 0.58, 95% CI 0.32–1.07, P = .08). Conclusion: TAC-corticosteroid combination therapy had a higher total remission rate at the sixth month but had a higher incidence of infection than TAC monotherapy in the treatment of IMN. The two therapeutic regimens had similar relapse rates.

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A comparison of cyclophosphamide versus tacrolimus in terms of treatment effect for idiopathic membranous nephropathy: A meta-analysis

Cited by 6 publications

References 33 publications

The Unique Difference Between Serum Level of Soluble Urokinase Plasminogen Activator Receptor (suPAR) in Steroid-Resistant Nephrotic Syndrome Children Treated with an Alkylating Agent and Calcineurin Inhibitors

The Unique Difference Between Serum Level of Soluble Urokinase Plasminogen Activator Receptor (suPAR) in Steroid-Resistant Nephrotic Syndrome Children Treated with an Alkylating Agent and Calcineurin Inhibitors

Efficacy and safety of tacrolimus monotherapy versus cyclophosphamide–corticosteroid combination therapy for idiopathic membranous nephropathy

Efficacy and safety of tacrolimus monotherapy versus tacrolimus-corticosteroid combination therapy for idiopathic membranous nephropathy

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