Cochrane · systematic review · CD003232
Interventions for renal vasculitis in adults
Walters, GD, Willis, NS, Cooper, TE, 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
61
current version
GRADE rated
45
No studies
16
Included studies
NR
No studies 16 · 26.2%Ungraded 0 · 0%Very low 0 · 0%Low 33 · 54.1%Moderate 12 · 19.7%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
Current version onlyPlasma exchange as adjunctive therapy for renal vasculitis
Population: adults with renal vasculitis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Death at one year | RR 1.04 [0.57, 1.92] | 5 studies · 267 participants | Low Downgraded: imprecision |
Serum creatinine at 1 year | no estimate extracted | 4 studies · 156 participants | Low |
Dialysis at one year | RR 0.45 [0.29, 0.72] | 6 studies · 235 participants | Low Downgraded: imprecision |
Sustained remission | RR 1.02 | 1 study · 704 participants | Low Downgraded: imprecision |
Relapse | no estimate extracted | NR | No studies |
Total number of adverse events | RR 1.01 [0.91, 1.12] | 5 studies · 956 participants | Low Downgraded: imprecision |
Serious infections | RR 1.26 [1.03, 1.54] | 5 studies · 956 participants | Low Downgraded: imprecision |
Pulse cyclophosphamide versus continuous cyclophosphamide for remission induction
Population: adults with renal vasculitis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Death at final Pulse cyclophosphamide vs continuous cyclophosphamide | RR 0.77 [0.44, 1.32] | 4 studies · 278 participants | Low Downgraded: risk of bias, imprecision |
Serum creatinine at 12 months Pulse cyclophosphamide vs continuous cyclophosphamide | no estimate extracted | 2 studies · 52 participants | Low Downgraded: imprecision |
Dialysis at end of study Pulse cyclophosphamide vs continuous cyclophosphamide | RR 1.9 [0.92, 3.91] | 4 studies · 245 participants | Low Downgraded: risk of bias, imprecision |
Remission at 6 months Pulse cyclophosphamide vs continuous cyclophosphamide | RR 1.03 [0.93, 1.13] | 2 studies · 176 participants | Low Downgraded: risk of bias, imprecision |
Relapse at the end of Pulse cyclophosphamide vs continuous cyclophosphamide | RR 1.79 [1.11, 2.87] | 4 studies · 235 participants | Low Downgraded: risk of bias, imprecision |
Adverse events ‐ treatment failure Pulse cyclophosphamide vs continuous cyclophosphamide | RR 1.36 [0.115, 12.56] | 2 studies · 82 participants | Low Downgraded: risk of bias, imprecision |
Serious infections Pulse cyclophosphamide vs continuous cyclophosphamide | RR 0.71 [0.38, 1.33] | 4 studies · 278 participants | Low Downgraded: risk of bias |
Rituximab versus cyclophosphamide for renal vasculitis for remission induction
Population: adults with renal vasculitis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Death at 6 months Rituximab vs cyclophosphamide | RR 1 [0.21, 4.7] | 2 studies · 241 participants | Moderate |
Kidney function Rituximab vs cyclophosphamide | no estimate extracted | NR | No studies |
Dialysis Rituximab vs cyclophosphamide | no estimate extracted | NR | No studies |
Remission at 6 months Rituximab vs cyclophosphamide | RR 1.02 [0.79, 1.32] | 2 studies · 236 participants | Moderate |
Relapse at 12 months Rituximab vs cyclophosphamide | RR 1.43 [0.18, 11.31] | 1 study · 38 participants | Low |
Serious adverse events Rituximab vs cyclophosphamide | RR 1.11 [0.72, 1.71] | 2 studies · 241 participants | Moderate |
Serious Infections Rituximab vs cyclophosphamide | RR 0.89 [0.62, 1.92] | 2 studies · 241 participants | Moderate |
Mycophenolate mofetil versus cyclophosphamide for remission induction
Population: adults with renal vasculitis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Death at 6 months Mycophenolate mofetil vs cyclophosphamide | RR 1.25 [0.35, 4.46] | 1 study · 140 participants | Low Downgraded: imprecision |
Kidney function Mycophenolate mofetil vs cyclophosphamide | no estimate extracted | NR | No studies |
Dialysis Mycophenolate mofetil vs cyclophosphamide | RR 1 [0.14, 6.9] | 1 study · 140 participants | Low Downgraded: imprecision |
Relapse at any time point Mycophenolate mofetil vs cyclophosphamide | RR 1.8 [1, 3.22] | 1 study · 127 participants | Low Downgraded: imprecision |
Remission at 6 months Mycophenolate mofetil vs cyclophosphamide | RR 1.17 [1.01, 1.35] | 3 studies · 216 participants | Moderate Downgraded: inconsistency |
Serious adverse events Mycophenolate mofetil vs cyclophosphamide | RR 1.25 | 1 study · 140 participants | Low Downgraded: imprecision |
Infection Mycophenolate mofetil vs cyclophosphamide | RR 1.27 [0.75, 2.16] | 3 studies · 216 participants | Moderate Downgraded: inconsistency |
Intravenous immunoglobulin versus placebo for renal vasculitis in adults
Population: adults with renal vasculitis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Death Intravenous immunoglobulin vs placebo | RR 0.2 [0.01, 3.88] | 1 study · 34 participants | Low Downgraded: imprecision |
Kidney function Intravenous immunoglobulin vs placebo | no estimate extracted | NR | No studies |
Dialysis Intravenous immunoglobulin vs placebo | no estimate extracted | NR | No studies |
Response at 3 months Intravenous immunoglobulin vs placebo | RR 2.33 [1.18, 4.61] | 1 study · 34 participants | Low Downgraded: imprecision |
Relapse at 3 months Intravenous immunoglobulin vs placebo | RR 1.17 [0.39, 3.56] | 1 study · 34 participants | Low Downgraded: imprecision |
Adverse events Intravenous immunoglobulin vs placebo | RR 3 | 1 study · 34 participants | Low Downgraded: imprecision |
Serious infection Intravenous immunoglobulin vs placebo | no estimate extracted | NR | No studies |
Azathioprine versus cyclophosphamide for maintenance therapy
Population: adults with renal vasculitis for maintenance therapy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Death (median Azathioprine vs cyclophosphamide | RR 0.77 [0.35, 1.72] | 1 study · 144 participants | Moderate Downgraded: imprecision |
Kidney function Azathioprine vs cyclophosphamide | no estimate extracted | NR | No studies |
Dialysis (median Azathioprine vs cyclophosphamide | RR 1.65 [0.57, 4.79] | 1 study · 144 participants | Moderate Downgraded: imprecision |
Relapse at 18 months Azathioprine vs cyclophosphamide | RR 1.13 [0.51, 2.5] | 1 study · 144 participants | Moderate Downgraded: imprecision |
Relapse (median Azathioprine vs cyclophosphamide | RR 1.46 [1, 2.14] | 1 study · 144 participants | Moderate Downgraded: imprecision |
Serious adverse events Azathioprine vs cyclophosphamide | RR 1.18 [0.45, 3.07] | 1 study · 144 participants | Moderate Downgraded: imprecision |
Infections Azathioprine vs cyclophosphamide | RR 1.03 [0.51, 2.06] | 1 study · 144 participants | Moderate Downgraded: imprecision |
Azathioprine versus methotrexate for maintenance therapy
Population: adults with renal vasculitis for maintenance therapy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Death Azathioprine vs methotrexate | RR 0.33 | 1 study · 126 participants | Low Downgraded: imprecision |
Kidney function Azathioprine vs methotrexate | no estimate extracted | NR | No studies |
Dialysis Azathioprine vs methotrexate | no estimate extracted | NR | No studies |
Relapse Azathioprine vs methotrexate | RR 1.1 [0.68, 1.77] | 1 study · 126 participants | Low Downgraded: imprecision |
Adverse events causing death or study drug discontinuation Azathioprine vs methotrexate | RR 0.58 [0.25, 1.38] | 1 study · 126 participants | Low Downgraded: imprecision |
Severe adverse events Azathioprine vs methotrexate | RR 0.58 | 1 study · 126 participants | Low Downgraded: imprecision |
Antibiotics versus placebo for maintenance therapy
Population: adults with renal vasculitis for maintenance therapy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Death at 6 months Antibiotics vs placebo | RR 0.33 [0.01, 7.76] | 1 study · 81 participants | Low Downgraded: risk of bias |
Kidney function Antibiotics vs placebo | no estimate extracted | NR | No studies |
Dialysis Antibiotics vs placebo | no estimate extracted | NR | No studies |
Remission at one year Antibiotics vs placebo | RR 1.14 [0.98, 1.33] | 2 studies · 111 participants | Low Downgraded: risk of bias, imprecision |
Relapse Antibiotics vs placebo | no estimate extracted | NR | No studies |
Adverse events causing study drug discontinuation Antibiotics vs placebo | RR 3.9 [0.88, 17.26] | 1 study · 81 participants | Low Downgraded: risk of bias |
Infection (urinary tract infection) Antibiotics vs placebo | RR 0.33 | 1 study · 81 participants | Low Downgraded: risk of bias |
Leflunomide versus methotrexate for maintenance therapy
Population: adults with renal vasculitis for maintenance therapy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Death Leflunomide vs methotrexate | no estimate extracted | NR | No studies |
Kidney function Leflunomide vs methotrexate | no estimate extracted | NR | No studies |
Dialysis Leflunomide vs methotrexate | no estimate extracted | NR | No studies |
Relapse Leflunomide vs methotrexate | RR 0.5 [0.22, 1.11] | 1 study · 54 participants | Low Downgraded: risk of bias |
Serious adverse events* Leflunomide vs methotrexate | RR 11.81 [0.69, 203.68] | 1 study · 54 participants | Low Downgraded: risk of bias |
Infection Leflunomide vs methotrexate | RR 1.17 [0.27, 106.88] | 1 study · 54 participants | Low Downgraded: risk of bias |
Plasma exchange as adjunctive therapy for renal vasculitis
Population: patients with renal vasculitis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Death at one year | RR 1.03 [0.62, 1.64] | 5 studies · 267 participants | Low Downgraded: imprecision |
Dialysis at one year | RR 0.45 [0.29, 0.72] | 6 studies · 235 participants | Low Downgraded: imprecision |
Serious infections | RR 1.19 [0.76, 1.84] | 4 studies · 252 participants | Low Downgraded: imprecision |
Pulse cyclophosphamide versus continuous cyclophosphamide for renal vasculitis for remission induction
Population: patients with renal vasculitis for remission induction
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Death at final Pulse cyclophosphamide vs continuous cyclophosphamide | RR 0.77 [0.44, 1.32] | 4 studies · 278 participants | Low Downgraded: risk of bias, imprecision |
Dialysis end of study Pulse cyclophosphamide vs continuous cyclophosphamide | RR 1.9 [0.92, 3.91] | 4 studies · 245 participants | Low Downgraded: risk of bias, imprecision |
Relapse ‐ untimed Pulse cyclophosphamide vs continuous cyclophosphamide | RR 1.79 [1.11, 2.87] | 4 studies · 235 participants | Low Downgraded: risk of bias, imprecision |
Serious infections Pulse cyclophosphamide vs continuous cyclophosphamide | RR 0.71 [0.38, 1.33] | 4 studies · 278 participants | Very low Downgraded: risk of bias, imprecision |
Rituximab versus cyclophosphamide for renal vasculitis for remission induction
Population: patients with renal vasculitis for remission induction
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Remission at 6 months Rituximab vs cyclophosphamide | RR 1.09 [0.92, 1.29] | 2 studies · 236 participants | Moderate |
Serious Infections Rituximab vs cyclophosphamide | RR 0.91 [0.42, 1.96] | 2 studies · 241 participants | High |
Mycophenolate mofetil versus cyclophosphamide for remission induction in renal vasculitis in adults
Population: patients with remission induction in renal vasculitis in adults
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Remission at 6 months Mycophenolate mofetil vs cyclophosphamide | RR 1.17 [1.02, 1.35] | 3 studies · 216 participants | High |
Intravenous immunoglobulin compared to placebo for renal vasculitis in adults
Population: patients with renal vasculitis in adults
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Response at 3 months Intravenous immunoglobulin vs placebo | RR 2.33 [1.18, 4.61] | 1 study · 34 participants | Moderate Downgraded: imprecision |
Small sample size Intravenous immunoglobulin vs placebo | no estimate extracted | 1 participants | Ungraded |
Leflunomide versus methotrexate for renal vasculitis for maintenance therapy
Population: patients with renal vasculitis for maintenance therapy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Relapse Leflunomide vs methotrexate | RR 0.5 [0.22, 1.11] | 1 study · 54 participants | Moderate |
Single small study Leflunomide vs methotrexate | no estimate extracted | 1 participants | Ungraded |
Azathioprine versus methotrexate for renal vasculitis for maintenance therapy
Population: patients with renal vasculitis for maintenance therapy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Adverse event causing death or study drug discontinuation Azathioprine vs methotrexate | RR 0.58 [0.25, 1.38] | 1 study · 126 participants | Moderate |
Relapse Azathioprine vs methotrexate | RR 1.1 [0.68, 1.77] | 1 study · 126 participants | Moderate |
Single small study Azathioprine vs methotrexate | no estimate extracted | 1 participants | Ungraded |
Azathioprine versus cyclophosphamide for renal vasculitis for maintenance therapy
Population: patients with renal vasculitis for maintenance therapy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Relapse Azathioprine vs cyclophosphamide | RR 1.13 [0.51, 2.5] | 1 study · 144 participants | Moderate Downgraded: imprecision |
Infections Azathioprine vs cyclophosphamide | RR 1.03 [0.51, 2.03] | 1 study · 144 participants | Moderate Downgraded: imprecision |
Small single study Azathioprine vs cyclophosphamide | no estimate extracted | 1 participants | Ungraded |
Antibiotics versus placebo for renal vasculitis for maintenance therapy
Population: patients with renal vasculitis for maintenance therapy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Remission at one year Antibiotics vs placebo | RR 1.14 [0.98, 1.33] | 2 studies · 111 participants | Low Downgraded: risk of bias, imprecision |