Cochrane · systematic review · CD004293
Immunosuppressive treatment for primary membranous nephropathy in adults with nephrotic syndrome
von Groote, TC, Williams, G, Au, EH, et al. · Cochrane Database of Systematic Reviews · 2021 · 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
36
current version
GRADE rated
36
No studies
0
Included studies
NR
No studies 0 · 0%Ungraded 0 · 0%Very low 17 · 47.2%Low 8 · 22.2%Moderate 11 · 30.6%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 versionsImmunosuppressive treatment versus placebo/no treatment/non‐immunosuppressive supportive treatment
Population: primary membranous nephropathy in adults with nephrotic syndrome
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Death at final Immunosuppressive treatment vs placebo/no treatment/non‐immunosuppressive supportive treatment | RR 0.73 [0.34, 1.59] | 16 studies · 944 participants | Moderate Downgraded: risk of bias |
End‐stage kidney disease at final Immunosuppressive treatment vs placebo/no treatment/non‐immunosuppressive supportive treatment | RR 0.59 [0.35, 0.99] | 16 studies · 944 participants | Moderate Downgraded: risk of bias |
Total remission (complete or partial) at final Immunosuppressive treatment vs placebo/no treatment/non‐immunosuppressive supportive treatment | RR 1.44 [1.05, 1.97] | 16 studies · 879 participants | Moderate Downgraded: risk of bias |
Complete remission at final Immunosuppressive treatment vs placebo/no treatment/non‐immunosuppressive supportive treatment | RR 1.7 [1.05, 2.75] | 16 studies · 879 participants | Moderate Downgraded: risk of bias |
Recurrence of disease (relapse) at final Immunosuppressive treatment vs placebo/no treatment/non‐immunosuppressive supportive treatment | RR 1.73 [1.05, 2.86] | 3 studies · 310 participants | Low Downgraded: risk of bias |
100% increase in serum creatinine at final Immunosuppressive treatment vs placebo/no treatment/non‐immunosuppressive supportive treatment | RR 0.46 [0.26, 0.8] | 8 studies · 447 participants | Moderate Downgraded: risk of bias |
Adverse events: temporary/permanent discontinuation or hospitalisation at final Immunosuppressive treatment vs placebo/no treatment/non‐immunosuppressive supportive treatment | RR 5.33 [2.19, 12.98] | 16 studies · 927 participants | Moderate Downgraded: risk of bias |
Adverse events: infection at 3 years Immunosuppressive treatment vs placebo/no treatment/non‐immunosuppressive supportive treatment | RR 2.95 [0.69, 12.61] | 1 study · 106 participants | Very low Downgraded: risk of bias |
Adverse events: malignancy at final Immunosuppressive treatment vs placebo/no treatment/non‐immunosuppressive supportive treatment | RR 1.03 [0.12, 9.14] | 2 studies · 182 participants | Very low Downgraded: risk of bias |
Oral alkylating agents ± steroids versus placebo/no treatment/steroids
Population: primary membranous nephropathy in adults with nephrotic syndrome
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Death at final Oral alkylating agents ± steroids vs placebo/no treatment/steroids | RR 0.76 [0.25, 2.3] | 7 studies · 440 participants | Low Downgraded: risk of bias |
End‐stage kidney disease at final Oral alkylating agents ± steroids vs placebo/no treatment/steroids | RR 0.42 [0.24, 0.74] | 9 studies · 537 participants | Moderate Downgraded: risk of bias |
Total remission (complete or partial) at final Oral alkylating agents ± steroids vs placebo/no treatment/steroids | RR 1.37 [1.04, 1.82] | 9 studies · 468 participants | Moderate Downgraded: risk of bias |
Complete remission at final Oral alkylating agents ± steroids vs placebo/no treatment/steroids | RR 2.12 [1.33, 3.38] | 8 studies · 432 participants | Moderate Downgraded: risk of bias |
Recurrence of disease (relapse) at final Oral alkylating agents ± steroids vs placebo/no treatment/steroids | RR 0.8 [0.4, 1.61] | 3 studies · 161 participants | Very low Downgraded: risk of bias |
100% increase in serum creatinine at final Oral alkylating agents ± steroids vs placebo/no treatment/steroids | RR 0.59 [0.3, 1.16] | 7 studies · 332 participants | Moderate Downgraded: risk of bias |
Adverse events ‐ temporary/permanent discontinuation or hospitalisation at final Oral alkylating agents ± steroids vs placebo/no treatment/steroids | RR 1.44 | 3 studies · 184 participants | Low Downgraded: risk of bias |
Adverse events ‐ infection at 3 years Oral alkylating agents ± steroids vs placebo/no treatment/steroids | RR 1.68 [0.3, 9.45] | 1 study · 70 participants | Very low Downgraded: risk of bias, imprecision |
Adverse events ‐ malignancy at final Oral alkylating agents ± steroids vs placebo/no treatment/steroids | RR 1.63 [0.21, 12.37] | 2 studies · 199 participants | Very low Downgraded: risk of bias |
Calcineurin inhibitors ± steroids versus placebo/no treatment/supportive treatment/steroids
Population: primary membranous nephropathy in adults with nephrotic syndrome
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Death at final Calcineurin inhibitors ± steroids vs placebo/no treatment/supportive treatment/steroids | RR 1.69 [0.46, 6.14] | 7 studies · 296 participants | Very low Downgraded: risk of bias |
End‐stage kidney disease at final Calcineurin inhibitors ± steroids vs placebo/no treatment/supportive treatment/steroids | RR 1.18 [0.54, 2.6] | 7 studies · 296 participants | Very low Downgraded: risk of bias |
Total remission at final Calcineurin inhibitors ± steroids vs placebo/no treatment/supportive treatment/steroids | RR 1.21 [0.62, 2.38] | 5 studies · 206 participants | Low Downgraded: risk of bias |
Complete remission at final Calcineurin inhibitors ± steroids vs placebo/no treatment/supportive treatment/steroids | RR 1.07 [0.51, 2.24] | 5 studies · 206 participants | Low Downgraded: risk of bias |
Recurrence of disease (relapse) at final Calcineurin inhibitors ± steroids vs placebo/no treatment/supportive treatment/steroids | RR 1.56 [0.79, 3.09] | 2 studies · 92 participants | Very low Downgraded: risk of bias |
100% increase in SCr at final Calcineurin inhibitors ± steroids vs placebo/no treatment/supportive treatment/steroids | RR 0.84 [0.37, 1.86] | 2 studies · 117 participants | Very low Downgraded: risk of bias |
Adverse events ‐ temporary or permanent discontinuation/hospitalisation at final Calcineurin inhibitors ± steroids vs placebo/no treatment/supportive treatment/steroids | RR 5.45 [0.29, 101.55] | 5 studies · 156 participants | Very low Downgraded: risk of bias |
Adverse events ‐ infection at 36 months Calcineurin inhibitors ± steroids vs placebo/no treatment/supportive treatment/steroids | RR 4.11 [0.94, 18.06] | 1 study · 73 participants | Very low Downgraded: risk of bias |
Adverse events ‐ malignancy at 36 months Calcineurin inhibitors ± steroids vs placebo/no treatment/supportive treatment/steroids | RR 2.79 [0.14, 56.57] | 1 study · 107 participants | Very low Downgraded: risk of bias |
Calcineurin inhibitors ± steroids versus alkylating agents ± steroids
Population: primary membranous nephropathy in adults with nephrotic syndrome
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Death at final Calcineurin inhibitors ± steroids vs alkylating agents ± steroids | RR 0.9 [0.35, 2.34] | 7 studies · 394 participants | Very low Downgraded: risk of bias |
End‐stage kidney disease at final Calcineurin inhibitors ± steroids vs alkylating agents ± steroids | RR 2.4 [0.64, 9.01] | 5 studies · 293 participants | Very low Downgraded: risk of bias |
Total remission at final Calcineurin inhibitors ± steroids vs alkylating agents ± steroids | RR 1.01 [0.89, 1.15] | 10 studies · 529 participants | Moderate Downgraded: risk of bias |
Complete remission at final Calcineurin inhibitors ± steroids vs alkylating agents ± steroids | RR 1.15 [0.84, 1.56] | 10 studies · 533 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Recurrence of disease (relapse) at final Calcineurin inhibitors ± steroids vs alkylating agents ± steroids | RR 2.13 [0.71, 6.37] | 6 studies · 295 participants | Low Downgraded: risk of bias |
100% increase in SCr at final Calcineurin inhibitors ± steroids vs alkylating agents ± steroids | RR 0.7 [0.3, 1.67] | 2 studies · 132 participants | Very low Downgraded: risk of bias |
Adverse events ‐ temporary or permanent discontinuation/hospitalisation at final Calcineurin inhibitors ± steroids vs alkylating agents ± steroids | RR 1.43 [0.31, 6.67] | 3 studies · 151 participants | Very low Downgraded: risk of bias |
Adverse events ‐ infection ( Calcineurin inhibitors ± steroids vs alkylating agents ± steroids | RR 0.86 [0.43, 1.71] | 9 studies · 552 participants | Low Downgraded: risk of bias |
Adverse events ‐ malignancy (range 30 to 36 months Calcineurin inhibitors ± steroids vs alkylating agents ± steroids | RR 0.18 [0.01, 3.69] | 2 studies · 127 participants | Very low Downgraded: risk of bias |