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2017 ; 4
(ä): 2054358117692559
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Calcineurin Inhibitors in the Treatment of Primary Focal Segmental
Glomerulosclerosis: A Systematic Review and Meta-analysis of the Literature
#MMPMID28321320
Laurin LP
; Nachman PH
; Foster BJ
Can J Kidney Health Dis
2017[]; 4
(ä): 2054358117692559
PMID28321320
show ga
PURPOSE OF REVIEW: Primary focal segmental glomerulosclerosis (FSGS) is the most
common cause of nephrotic syndrome in adults. Glucocorticoids have been evaluated
in the treatment of primary FSGS in numerous retrospective studies. Evidence
suggesting a role for including calcineurin inhibitors (CNIs) in early therapy
remains limited. The aim of this study was to systematically review the
literature examining the efficacy of CNIs in the treatment of primary FSGS both
as first-line therapy and as an adjunctive agent in steroid-resistant patients,
with respect to remission in proteinuria and renal survival. SOURCES OF
INFORMATION: PubMed and EMBASE were searched from inception to August 2014 for
prospective controlled trials, and case-control and cohort studies. FINDINGS:
After systematically applying our inclusion criteria, a total of 152 titles and
abstracts were identified. Six randomized controlled trials and 2 cohort studies
were reviewed. Three randomized controlled trials compared CNIs with placebo or
supportive therapy. The pooled relative "risk" of proteinuria remission
associated with cyclosporine was 7.0 (95% confidence interval, 2.9-16.8) compared
with placebo/supportive therapy. There was very low heterogeneity among these
studies with an I-squared of 0%. Three studies compared CNIs with another
immunosuppressive agent. All prospective trials were conducted in patients with
primary FSGS deemed steroid-resistant. LIMITATIONS: The relatively small number
of included studies and their heterogeneity with respect to treatment protocols,
and possible publication bias, limit conclusions drawn from this systematic
review. IMPLICATIONS: The efficacy of CNIs has been evaluated in
steroid-resistant primary FSGS patients. There is no evidence supporting their
role as first-line therapy. Further studies are needed to determine this role.