Efficacy and Safety of Cyclosporine a for Patients with Steroid-resistant Nephrotic Syndrome: a Meta-analysis

Overview

Journal BMC Nephrol

Publisher Biomed Central

Specialty Nephrology

Date 2019 Oct 25

PMID 31646979

Citations 3

Authors

Hong-Yan Li

Xialan Zhang

Tianbiao Zhou

Zhiqing Zhong

Hongzhen Zhong

Affiliations

Soon will be listed here.

Abstract

Background: The purpose of this study was to determine efficacy and safety of cyclosporine A (CsA) for patients with steroid-resistant nephrotic syndrome (SRNS).

Methods: The Cochrane Library and PubMed were searched to extract the associated studies on Oct 10, 2018, and the meta-analysis method was used to pool and analyze the applicable investigations included in this study. The P(opulation) I(ntervention) C(omparison) O(utcome) of the study were defined as follows: P: Patients with SRNS; I: treated with CsA, cyclophosphamide (CYC), tacrolimus (TAC) or placebo/not treatment (P/NT); C: CsA vs. placebo/nontreatment (P/NT), CsA vs. CYC, CsA vs. TAC; O: complete remission (CR), total remission (TR; complete or partial remission (PR)), urine erythrocyte number, proteinuria levels, albumin, proteinuria, serum creatinine, and plasma cholesterol, etc. Data were extracted and pooled using RevMan 5.3.

Results: In the therapeutic regimen of CsA vs. placebo/nontreatment (P/NT), the results indicated that the CsA group had high values of CR, TR, and low values of proteinuria, serum creatinine, and plasma cholesterol when compared with those in the placebo group. In comparing CsA vs. cyclophosphamide (CYC), the results indicated that the CsA group had higher TR than the CYC group. In comparing CsA vs. tacrolimus (TAC), the results revealed insignificant differences in CR, and TR between the CsA and TAC groups. The safety of CsA was also assessed. The incidence of gum hyperplasia in CsA group was higher than that in the P/NT group, with no differences in incidence of infections or hypertension between CsA and P/NT groups. There was no difference in the incidence of hypertension between the CsA and TAC groups.

Conclusions: CsA is an effective and safe agent in the therapy of patients with SRNS.

Citing Articles

Comparative Efficacy of Nonsteroid Immunosuppressive Medications in Childhood Nephrotic Syndrome.

Robinson C, Aman N, Banh T, Brooke J, Chanchlani R, Cuthbertson B JAMA Pediatr. 2025; 179(3):321-331.

PMID: 39869322 PMC: 11773402. DOI: 10.1001/jamapediatrics.2024.5286.

The Pathogenesis of Nephrotic Syndrome: A Perspective from B Cells.

Zhu S, Zhang J, Gao L, Ye Q, Mao J Kidney Dis (Basel). 2024; 10(6):531-544.

PMID: 39664337 PMC: 11631018. DOI: 10.1159/000540511.

Clinical features and effects of cyclosporine in the treatment of psoriasis: a systemic review and meta-analysis.

Li Z, Pei B, Lei T, Yao M, Niu Y, Zhou P Arch Dermatol Res. 2024; 316(10):705.

PMID: 39460805 DOI: 10.1007/s00403-024-03425-y.

Role of topical and systemic immunosuppression in aqueous-deficient dry eye disease.

Kate A, Shanbhag S, Donthineni P, Amescua G, Perez Quinones V, Basu S Indian J Ophthalmol. 2023; 71(4):1176-1189.

PMID: 37026249 PMC: 10276741. DOI: 10.4103/IJO.IJO_2818_22.

References

Horinouchi T, Sako M, Nakanishi K, Ishikura K, Ito S, Nakamura H . Study protocol: mycophenolate mofetil as maintenance therapy after rituximab treatment for childhood-onset, complicated, frequently-relapsing nephrotic syndrome or steroid-dependent nephrotic syndrome: a multicenter double-blind, randomized,.... BMC Nephrol. 2018; 19(1):302. PMC: 6211590. DOI: 10.1186/s12882-018-1099-7. View

Varner J, Chryst-Stangl M, Esezobor C, Solarin A, Wu G, Lane B . Genetic Testing for Steroid-Resistant-Nephrotic Syndrome in an Outbred Population. Front Pediatr. 2018; 6:307. PMC: 6204400. DOI: 10.3389/fped.2018.00307. View

Akchurin O, Kaskel F . Late steroid resistance in childhood nephrotic syndrome: do we now know more than 40 years ago?. Pediatr Nephrol. 2013; 28(8):1157-60. DOI: 10.1007/s00467-013-2509-5. View

Siji A, Karthik K, Pardeshi V, Hari P, Vasudevan A . Targeted gene panel for genetic testing of south Indian children with steroid resistant nephrotic syndrome. BMC Med Genet. 2018; 19(1):200. PMC: 6245897. DOI: 10.1186/s12881-018-0714-6. View

Querfeld U, Weber L . Mycophenolate mofetil for sustained remission in nephrotic syndrome. Pediatr Nephrol. 2018; 33(12):2253-2265. DOI: 10.1007/s00467-018-3970-y. View

Tullus K, Webb H, Bagga A . Management of steroid-resistant nephrotic syndrome in children and adolescents. Lancet Child Adolesc Health. 2018; 2(12):880-890. DOI: 10.1016/S2352-4642(18)30283-9. View

Ponticelli C, Rizzoni G, Edefonti A, Altieri P, Rivolta E, Rinaldi S . A randomized trial of cyclosporine in steroid-resistant idiopathic nephrotic syndrome. Kidney Int. 1993; 43(6):1377-84. DOI: 10.1038/ki.1993.194. View

Groenendyk J, Paskevicius T, Urra H, Viricel C, Wang K, Barakat K . Cyclosporine A binding to COX-2 reveals a novel signaling pathway that activates the IRE1α unfolded protein response sensor. Sci Rep. 2018; 8(1):16678. PMC: 6232179. DOI: 10.1038/s41598-018-34891-w. View

Garin E, Orak J, Hiott K, Sutherland S . Cyclosporine therapy for steroid-resistant nephrotic syndrome. A controlled study. Am J Dis Child. 1988; 142(9):985-8. DOI: 10.1001/archpedi.1988.02150090083029. View

10.

Asharam K, Bhimma R, David V, Coovadia H, Qulu W, Naicker T . V260E Is a Frequent Cause of Steroid-Resistant Nephrotic Syndrome in Black South African Children. Kidney Int Rep. 2018; 3(6):1354-1362. PMC: 6224675. DOI: 10.1016/j.ekir.2018.07.017. View

11.

Hodson E, Wong S, Willis N, Craig J . Interventions for idiopathic steroid-resistant nephrotic syndrome in children. Cochrane Database Syst Rev. 2016; 10:CD003594. PMC: 6457874. DOI: 10.1002/14651858.CD003594.pub5. View

12.

Geng H, Ji L, Chen C, Tu J, Li H, Bao R . [Mycophenolate mofetil versus cyclosporine A in children with primary refractory nephrotic syndrome]. Zhonghua Er Ke Za Zhi. 2018; 56(9):651-656. DOI: 10.3760/cma.j.issn.0578-1310.2018.09.004. View

13.

Li Z, Hu M, Zhang C, Wang Y . Efficacy and safety of tacrolimus vs. cyclophosphamide for idiopathic membranous nephropathy: A meta-analysis of Chinese adults. J Huazhong Univ Sci Technolog Med Sci. 2015; 35(5):623-628. DOI: 10.1007/s11596-015-1480-8. View

14.

Choudhry S, Bagga A, Hari P, Sharma S, Kalaivani M, Dinda A . Efficacy and safety of tacrolimus versus cyclosporine in children with steroid-resistant nephrotic syndrome: a randomized controlled trial. Am J Kidney Dis. 2009; 53(5):760-9. DOI: 10.1053/j.ajkd.2008.11.033. View

15.

Plank C, Kalb V, Hinkes B, Hildebrandt F, Gefeller O, Rascher W . Cyclosporin A is superior to cyclophosphamide in children with steroid-resistant nephrotic syndrome-a randomized controlled multicentre trial by the Arbeitsgemeinschaft für Pädiatrische Nephrologie. Pediatr Nephrol. 2008; 23(9):1483-93. PMC: 2730636. DOI: 10.1007/s00467-008-0794-1. View

16.

Jiang X, Shen W, Xu X, Shen X, Li Y, He Q . Immunosuppressive therapy for steroid-resistant nephrotic syndrome: a Bayesian network meta-analysis of randomized controlled studies. Clin Exp Nephrol. 2017; 22(3):562-569. DOI: 10.1007/s10157-017-1484-8. View

17.

Gellermann J, Schaefer F, Querfeld U . Serum suPAR levels are modulated by immunosuppressive therapy of minimal change nephrotic syndrome. Pediatr Nephrol. 2014; 29(12):2411-4. DOI: 10.1007/s00467-014-2913-5. View

18.

Dogra S, Kaskel F . Steroid-resistant nephrotic syndrome: a persistent challenge for pediatric nephrology. Pediatr Nephrol. 2016; 32(6):965-974. DOI: 10.1007/s00467-016-3459-5. View

19.

Gellermann J, Ehrich J, Querfeld U . Sequential maintenance therapy with cyclosporin A and mycophenolate mofetil for sustained remission of childhood steroid-resistant nephrotic syndrome. Nephrol Dial Transplant. 2011; 27(5):1970-8. DOI: 10.1093/ndt/gfr572. View

20.

Loboda A, Mucha O, Podkalicka P, Sobczak M, Miksza-Cybulska A, Kaczara P . Kidney injury by cyclosporine A is aggravated in heme oxygenase-1 deficient mice and involves regulation of microRNAs. Acta Biochim Pol. 2018; 65(4):613-620. DOI: 10.18388/abp.2018_2658. View