Enhanced Steroid Therapy in Adult Minimal Change Nephrotic Syndrome: A Systematic Review and Meta-analysis.
The best regimen for adult minimal change nephrotic syndrome (MCNS) is still unknown. Due to an excessive number of adverse events caused by oral steroid monotherapy, enhanced steroid therapy (low dose of prednisolone with a short course of methylprednisolone or with another immunosuppressant) has been studied extensively for years. In this study, the PubMed, Embase, EBSCO and Cochrane Library databases were searched for clinical trials which compared enhanced steroid therapy with oral steroid monotherapy in adult MCNS and a meta-analysis was performed. Seven studies involving 357 patients were included. We found that patients treated with enhanced steroid therapy responded more quickly to complete remission (CR) [mean difference = -9.52, 95% confidence interval (CI): -12.66--6.39, p<0.00001] and showed fewer adverse events [risk radio (RR) = 0.72, 95% CI: 0.54-0.97, p=0.03] than patients receiving oral steroid monotherapy. The CR rate (RR= 0.96, 95% CI: 0.83-1.10, p=0.53) and relapse rate (RR=0.87, 95% CI: 0.57-1.34, p=0.53) were similar in both groups.
Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, China.
Lingfei
L
Zhao
Jun
J
Cheng
Jingyi
J
Zhou
Congcong
C
Wu
Jianghua
J
Chen
D000328:Adult; D016208:Databases, Factual; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008775:Methylprednisolone / Q000627:therapeutic use*; D009402:Nephrosis, Lipoid / Q000139:chemically induced / Q000188:drug therapy*; D009404:Nephrotic Syndrome / Q000188:drug therapy* / Q000503:physiopathology; D020551:Pulse Therapy, Drug / Q000379:methods*; D012008:Recurrence; D012074:Remission Induction
D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D008775:Methylprednisolone