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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 Clin+Kidney+J
2016 ; 9
(3
): 387-96
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Efficacy and safety of adrenocorticotropic hormone treatment in glomerular
diseases: a systematic review and meta-analysis
#MMPMID27274822
Kittanamongkolchai W
; Cheungpasitporn W
; Zand L
Clin Kidney J
2016[Jun]; 9
(3
): 387-96
PMID27274822
show ga
BACKGROUND: There is growing evidence that adrenocorticotropic hormone (ACTH) may
be effective in treating various forms of glomerular diseases. However, the
efficacy of treatment and frequency of adverse effects associated with the use of
ACTH in glomerular diseases are unknown. A systematic review and meta-analysis of
the literature was performed. METHODS: A literature search was performed using
Medline, Embase, Google Scholar and the Cochrane Database of Systematic Reviews
from inception through 18 July 2015. Studies assessing the efficacy and safety of
ACTH treatment in adults with glomerular diseases were included. RESULTS: Of the
343 identified citations, 18 evaluated the drug efficacy and 12 evaluated the
adverse effects. The most common glomerular diseases were membranous nephropathy
(MN), primary focal segmental glomerulosclerosis (FSGS) and minimal change
disease (MCD). The overall rate of complete remission in MN was 80% at 0-6
months, 69% at >6-12 months, 90% at >12-24 months and 95% beyond 24 months of
follow-up. Fifty percent of primary FSGS and MCD patients treated with ACTH were
in remission at 6 months, but the relapse rate was high after ACTH
discontinuation (17%). Evidence of ACTH efficacy for other glomerular diseases
was scarce. Edema was the most commonly reported adverse effect {incidence rate
[IR] 0.10 [95% confidence interval (CI) 0.04-0.18]} followed by insomnia [IR 0.08
(95% CI 0.03-0.15)]. The dropout rate due to adverse events was 7%, mostly due to
edema and weight gain. CONCLUSIONS: ACTH is a well-tolerated therapy and is most
promising when treating patients with MN. There may be a potential role for ACTH
in patients with MCD and FSGS, but data are lacking.