Cochrane · systematic review · CD002290
Non‐corticosteroid immunosuppressive medications for steroid‐sensitive nephrotic syndrome in children
Larkins, NG, Liu, ID, Willis, NS, et al. · Cochrane Database of Systematic Reviews · 2020 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
75
current version
GRADE rated
57
No studies
16
Included studies
NR
No studies 16 · 21.3%Ungraded 2 · 2.7%Very low 13 · 17.3%Low 40 · 53.3%Moderate 4 · 5.3%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Show all 2 versionsRituximab versus placebo or control for steroid‐sensitive nephrotic syndrome in children
Population: SSNS in children
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Relapses at 3 months Rituximab vs placebo or control | RR 0.32 [0.14, 0.7] | 3 studies · 132 participants | Moderate Downgraded: imprecision |
Relapses at 6 months Rituximab vs placebo or control | RR 0.23 [0.12, 0.43] | 5 studies · 269 participants | Moderate Downgraded: risk of bias, imprecision |
Relapses at 12 months Rituximab vs placebo or control | RR 0.63 [0.42, 0.93] | 3 studies · 198 participants | Moderate Downgraded: imprecision |
Frequent relapses Rituximab vs placebo or control | no estimate extracted | NR | No studies |
Relapse rate/patient/month Rituximab vs placebo or control | no estimate extracted | NR | No studies |
Adverse effects: moderate to severe Infusion reactions Rituximab vs placebo or control | RR 5.83 [1.34, 25.29] | 4 studies · 252 participants | Low Downgraded: imprecision |
Adverse effects: severe infection Rituximab vs placebo or control | RR 0.9 [0.26, 3.15] | 3 studies · 222 participants | Low Downgraded: imprecision |
Adverse effects: arthropathy Rituximab vs placebo or control | RR 3.92 [0.45, 33.98] | 2 studies · 84 participants | Low Downgraded: imprecision |
Mycophenolate mofetil versus levamisole for steroid‐sensitive nephrotic syndrome in children
Population: SSNS in children
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Relapses at 12 months Mycophenolate mofetil vs levamisole | RR 0.9 [0.7, 1.16] | 1 study · 149 participants | Low |
Frequent relapses at 12 months Mycophenolate mofetil vs levamisole | RR 0.88 [0.41, 1.87] | 1 study · 149 participants | Low |
Relapse rate/patient/month Mycophenolate mofetil vs levamisole | no estimate extracted | NR | No studies |
Adverse effects: peritonitis Mycophenolate mofetil vs levamisole | RR 0.32 [0.03, 3.01] | 1 study · 149 participants | Very low |
Adverse effects: abdominal pain Mycophenolate mofetil vs levamisole | RR 1.26 [0.66, 2.4] | 1 study · 149 participants | Low |
Adverse effects: anaemia Mycophenolate mofetil vs levamisole | RR 0.48 [0.04, 5.18] | 1 study · 149 participants | Very low |
Adverse effects: leukopenia Mycophenolate mofetil vs levamisole | RR 2.88 [0.12, 69.65] | 1 study · 149 participants | Very low |
Mycophenolate mofetil versus cyclosporin for steroid‐sensitive nephrotic syndrome in children
Population: SSNS in children
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Relapse at 12 months Mycophenolate mofetil vs cyclosporin | RR 1.9 [0.66, 5.46] | 2 studies · 82 participants | Low Downgraded: imprecision |
Frequent relapses Mycophenolate mofetil vs cyclosporin | no estimate extracted | NR | No studies |
Relapse rate/year Mycophenolate mofetil vs cyclosporin | no estimate extracted | 3 studies · 3 participants | Low Downgraded: imprecision |
Adverse effects: hypertension Mycophenolate mofetil vs cyclosporin | RR 0.3 [0.09, 1.07] | 3 studies · 144 participants | Low Downgraded: imprecision |
Adverse effects: hypertrichosis Mycophenolate mofetil vs cyclosporin | RR 0.23 [0.1, 0.5] | 3 studies · 140 participants | Low Downgraded: risk of bias, imprecision |
Adverse effects: lymphopenia Mycophenolate mofetil vs cyclosporin | RR 0.64 [0.08, 4.85] | 2 studies · 84 participants | Low Downgraded: imprecision |
Adverse effects: gum hypertrophy Mycophenolate mofetil vs cyclosporin | RR 0.09 [0.02, 0.47] | 3 studies · 144 participants | Low Downgraded: imprecision |
Adverse effects: reduced GFR Mycophenolate mofetil vs cyclosporin | RR 0.33 [0.01, 7.45] | 1 study · 24 participants | Low Downgraded: imprecision |
Levamisole versus steroids or placebo or both, or no treatment for steroid‐sensitive nephrotic syndrome in children
Population: SSNS in children
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Relapse during treatment (4 to 12 months) Levamisole vs steroids or placebo or both, or no treatment | RR 0.52 [0.33, 0.82] | 8 studies · 474 participants | Low Downgraded: inconsistency |
Relapse at 6 to 12 months Levamisole vs steroids or placebo or both, or no treatment | RR 0.65 [0.48, 0.88] | 8 studies · 462 participants | Low Downgraded: inconsistency |
Frequent relapses Levamisole vs steroids or placebo or both, or no treatment | no estimate extracted | NR | No studies |
Mean relapse rate/patient/month Levamisole vs steroids or placebo or both, or no treatment | no estimate extracted | 2 studies · 2 participants | Very low Downgraded: inconsistency |
Adverse effects: leucopenia Levamisole vs steroids or placebo or both, or no treatment | RR 4.18 [0.72, 24.21] | 3 studies · 214 participants | Low Downgraded: inconsistency |
Adverse effects: ANCA positive/arthritis Levamisole vs steroids or placebo or both, or no treatment | RR 3 [0.13, 71.92] | 1 study · 100 participants | Low Downgraded: inconsistency |
Levamisole versus cyclophosphamide for steroid‐sensitive nephrotic syndrome in children
Population: SSNS in children
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Relapse: at end of therapy Levamisole vs cyclophosphamide | RR 2.14 [0.22, 20.95] | 2 studies · 97 participants | Very low Downgraded: risk of bias |
Relapse: at 6 to 9 months after therapy Levamisole vs cyclophosphamide | RR 1.17 [0.76, 1.81] | 2 studies · 97 participants | Low Downgraded: risk of bias |
Relapse: at 12 months after therapy Levamisole vs cyclophosphamide | RR 0.89 [0.68, 1.16] | 1 study · 40 participants | Low Downgraded: risk of bias |
Relapse: at 24 months after therapy Levamisole vs cyclophosphamide | RR 0.89 [0.73, 1.1] | 1 study · 40 participants | Low Downgraded: risk of bias |
Frequent relapses Levamisole vs cyclophosphamide | no estimate extracted | NR | No studies |
Mean relapse rate/patient/month Levamisole vs cyclophosphamide | no estimate extracted | NR | No studies |
Adverse effects: infection Levamisole vs cyclophosphamide | RR 1.08 [0.67, 1.75] | 1 study · 40 participants | Low Downgraded: risk of bias |
Adverse effects: leucopenia Levamisole vs cyclophosphamide | RR 0.25 [0.04, 1.48] | 2 studies · 97 participants | Low Downgraded: risk of bias |
Adverse effects: abnormal liver function tests Levamisole vs cyclophosphamide | RR 0.33 [0.01, 7.72] | 1 study · 40 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Cyclosporin plus prednisolone versus prednisolone alone for steroid‐sensitive nephrotic syndrome in children
Population: SSNS in children
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Relapse at 6 months Cyclosporin plus prednisolone vs prednisolone alone | RR 0.33 [0.13, 0.83] | 1 study · 104 participants | Low Downgraded: risk of bias |
Relapse at 12 months Cyclosporin plus prednisolone vs prednisolone alone | RR 0.72 [0.46, 1.13] | 1 study · 104 participants | Low Downgraded: risk of bias |
Frequent relapses Cyclosporin plus prednisolone vs prednisolone alone | no estimate extracted | NR | No studies |
Mean relapse rate/patient/month Cyclosporin plus prednisolone vs prednisolone alone | no estimate extracted | NR | No studies |
Adverse effects: number needing cytotoxic agents Cyclosporin plus prednisolone vs prednisolone alone | RR 0.47 [0.18, 1.23] | 1 study · 104 participants | Very low Downgraded: risk of bias |
Adverse effects: creatinine at the end of study Cyclosporin plus prednisolone vs prednisolone alone | no estimate extracted | 1 study · 87 participants | Very low Downgraded: risk of bias |
Alkylating agents versus cyclosporin for steroid‐sensitive nephrotic syndrome in children
Population: SSNS in children
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Relapse at end of therapy (6 to 9 months) Alkylating agents vs cyclosporin | RR 0.91 [0.55, 1.48] | 2 studies · 95 participants | Low Downgraded: risk of bias |
Relapse at 12 to 24 months Alkylating agents vs cyclosporin | RR 0.51 [0.35, 0.74] | 2 studies · 95 participants | Low Downgraded: risk of bias |
Frequent relapses Alkylating agents vs cyclosporin | no estimate extracted | NR | No studies |
Mean relapse rate/patient/month Alkylating agents vs cyclosporin | no estimate extracted | NR | No studies |
Adverse effects: serum creatinine Alkylating agents vs cyclosporin | RR 0.2 [0.02, 1.69] | 2 studies · 106 participants | Low Downgraded: risk of bias |
Adverse effects: hypertrichosis Alkylating agents vs cyclosporin | RR 0.06 [0.01, 0.4] | 2 studies · 106 participants | Low Downgraded: risk of bias |
Adverse effects: gum hypertrophy Alkylating agents vs cyclosporin | RR 0.08 [0.01, 0.59] | 2 studies · 106 participants | Low Downgraded: risk of bias |
Adverse effects: hypertension Alkylating agents vs cyclosporin | RR 0.33 [0.01, 7.72] | 1 study · 40 participants | Very low Downgraded: risk of bias |
Adverse effects: leucopenia Alkylating agents vs cyclosporin | RR 29.84 [1.84, 483.93] | 1 study · 66 participants | Very low Downgraded: risk of bias |
Alkylating agents versus steroids, placebo or both for steroid‐sensitive nephrotic syndrome in children
Population: SSNS in children
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Relapse at 6 to 12 months Alkylating agents vs steroids, placebo or both | RR 0.44 [0.32, 0.6] | 6 studies · 202 participants | Moderate Downgraded: risk of bias |
Relapse at 12 to 24 months Alkylating agents vs steroids, placebo or both | RR 0.2 [0.09, 0.46] | 4 studies · 59 participants | Low Downgraded: risk of bias |
Frequent relapses Alkylating agents vs steroids, placebo or both | no estimate extracted | NR | No studies |
Mean relapse rate/patient/month Alkylating agents vs steroids, placebo or both | no estimate extracted | NR | No studies |
CPA: leucopenia Alkylating agents vs steroids, placebo or both | RR 10.63 [1.45, 78.05] | NR | Ungraded |
Chlorambucil: leucopenia Alkylating agents vs steroids, placebo or both | RR 2.5 [0.11, 54.87] | NR | Ungraded |
Intravenous versus oral cyclophosphamide for steroid‐sensitive nephrotic syndrome in children
Population: SSNS in children
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Relapse at 6 months Intravenous vs oral cyclophosphamide | RR 0.54 [0.34, 0.88] | 2 studies · 83 participants | Low Downgraded: risk of bias |
Continuing frequently‐relapsing or steroid‐dependent SSNS at 6 months Intravenous vs oral cyclophosphamide | RR 0.4 [0.18, 0.89] | 1 study · 47 participants | Low Downgraded: risk of bias |
Relapse at end of study Intravenous vs oral cyclophosphamide | RR 0.99 [0.76, 1.29] | 2 studies · 83 participants | Low Downgraded: risk of bias |
Mean relapse rate/patient/month Intravenous vs oral cyclophosphamide | no estimate extracted | NR | No studies |
Adverse events: leucopenia Intravenous vs oral cyclophosphamide | RR 0.37 [0.09, 1.51] | 2 studies · 83 participants | Low Downgraded: risk of bias |
Adverse events: hair loss Intravenous vs oral cyclophosphamide | RR 0.19 [0.04, 1.03] | 2 studies · 83 participants | Low Downgraded: risk of bias |
Adverse events: all infections Intravenous vs oral cyclophosphamide | RR 0.14 [0.03, 0.72] | 2 studies · 83 participants | Low Downgraded: risk of bias |
Adverse events: nausea and vomiting Intravenous vs oral cyclophosphamide | RR 4.07 [0.21, 80.51] | 1 study · 47 participants | Very low Downgraded: risk of bias |
Cyclophosphamide versus chlorambucil for steroid‐sensitive nephrotic syndrome in children
Population: SSNS in children
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Relapse at 12 months Cyclophosphamide vs chlorambucil | RR 1.15 [0.69, 1.94] | 1 study · 50 participants | Low Downgraded: risk of bias |
Relapse at 24 months Cyclophosphamide vs chlorambucil | RR 1.31 [0.8, 2.13] | 1 study · 50 participants | Low Downgraded: risk of bias |
Frequent relapses Cyclophosphamide vs chlorambucil | no estimate extracted | NR | No studies |
Mean relapse rate/patient/month Cyclophosphamide vs chlorambucil | no estimate extracted | NR | No studies |
Adverse effects: lymphopenia Cyclophosphamide vs chlorambucil | RR 0.43 [0.21, 0.87] | 1 study · 50 participants | Low Downgraded: risk of bias |
Adverse effects: thrombocytopenia Cyclophosphamide vs chlorambucil | RR 0.43 [0.21, 0.87] | 1 study · 50 participants | Low Downgraded: risk of bias |
Adverse effects: severe infection Cyclophosphamide vs chlorambucil | RR 4.63 [0.23, 91.81] | 1 study · 50 participants | Very low Downgraded: risk of bias |
Adverse effects: hair loss Cyclophosphamide vs chlorambucil | RR 8.33 [0.47, 147.07] | 1 study · 50 participants | Very low Downgraded: risk of bias |