Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Faculty of Medicine, Department of Anesthesiology, University of Malaya, Kuala Lumpur, Malaysia.
PLoS One. 2024 Jul 31;19(7):e0307981. doi: 10.1371/journal.pone.0307981. eCollection 2024.
There is limited evidence on which immunosuppressive agents produce the best outcomes for adult patients with steroid-dependent or frequently relapsing nephrotic syndrome (SDNS/FRNS). This review compares the remission rate and adverse effects of various immunosuppressants used.
Studies of adult patients with biopsy-proven SDNS/FRNS, administered any immunosuppressive agents and reported complete remission results as one of the clinical outcomes were included. Articles were independently screened by two researchers. ROBINS-I was used for risk of bias assessment. Random-effects model was used for statistical analysis and corresponding 95% confidence intervals (CIs) were calculated.
574 patients across 28 studies were included in the analysis. Patients receiving rituximab have a complete remission rate of 89% (95% CI = 83% to 94%; τ2 = 0.0070; I2 = 62%; overall p < 0.01, low certainty) and adverse event rate of 0.26, cyclosporine (CR 40%; 95% CI = 21% to 59%; τ2 = 0.0205; I2 = 55%; overall p = 0.08, low certainty), tacrolimus (CR 84%; 95% CI = 70% to 98%; τ2 = 0.0060; I2 = 33%; overall p = 0.21, moderate certainty), mycophenolate mofetil (CR 82%; 95% CI = 74% to 90%; τ2 < 0.0001; I2 = 15%; overall p = 0.32, moderate certainty) and cyclophosphamide (CR 79%; 95% CI = 69% to 89%; τ2 = 0; I2 = 0%; overall p = 0.52, moderate certainty).
Among the commonly used immunosuppressive agents, only rituximab has a statistically significant effect in achieving complete remission among patients with SDNS/FRNS and has a relatively good safety profile, but this is limited by low quality of evidence with high degree of heterogeneity causing a lack of statistical power.
对于患有激素依赖性或频繁复发的肾病综合征（SDNS/FRNS）的成年患者，哪种免疫抑制剂的效果最佳，目前相关证据有限。本综述比较了各种免疫抑制剂的缓解率和不良反应。
纳入了经活检证实为 SDNS/FRNS 的成年患者，给予任何免疫抑制剂治疗，并报告完全缓解结果作为其中一项临床结局的研究。文章由两名研究人员独立筛选。采用 ROBINS-I 评估偏倚风险。采用随机效应模型进行统计学分析，并计算相应的 95%置信区间（CI）。
纳入了 28 项研究中的 574 名患者。接受利妥昔单抗治疗的患者完全缓解率为 89%（95%CI=83%94%；τ2=0.0070；I2=62%；总体 p<0.01，低质量证据），不良反应发生率为 0.26%，环孢素（CR40%；95%CI=21%59%；τ2=0.0205；I2=55%；总体 p=0.08，低质量证据）、他克莫司（CR84%；95%CI=70%98%；τ2=0.0060；I2=33%；总体 p=0.21，中等质量证据）、霉酚酸酯（CR82%；95%CI=74%90%；τ2<0.0001；I2=15%；总体 p=0.32，中等质量证据）和环磷酰胺（CR79%；95%CI=69%~89%；τ2=0；I2=0%；总体 p=0.52，中等质量证据）。
在常用的免疫抑制剂中，只有利妥昔单抗在 SDNS/FRNS 患者中实现完全缓解方面具有统计学意义，且具有相对较好的安全性，但这受到高度异质性导致统计效能不足的低质量证据限制。
