PMID- 29069848
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20191120
IS  - 1949-2553 (Electronic)
IS  - 1949-2553 (Linking)
VI  - 8
IP  - 42
DP  - 2017 Sep 22
TI  - Efficacy and safety of immunosuppressive medications for steroid-resistant 
      nephrotic syndrome in children: a systematic review and network meta-analysis.
PG  - 73050-73062
LID - 10.18632/oncotarget.20377 [doi]
AB  - BACKGROUND: Conventional meta-analyses and randomized controlled trials have 
      shown inconsistent results regarding the efficacy of immunosuppressants for 
      pediatric steroid-resistant nephrotic syndrome (SRNS). OBJECTIVE: To conduct a 
      network meta-analysis aimed at evaluating the efficacy and safety of available 
      immunosuppressive agents in pediatric patients with SRNS. STUDY METHODS: MEDLINE, 
      the Cochrane Central Register of Controlled Trials, and EMBASE were searched on 
      January 2017. Data from randomized controlled trials (RCTs) were included. The 
      main outcomes analyzed were efficacy [number/portion with complete remission 
      (CR), number/portion with partial remission (PR), and total number/portion in 
      remission (TR)] and safety [adverse secondary event (ASE) rates]. RESULTS: A 
      meta-analysis of 18 RCTs showed that tacrolimus was more efficacious for 
      achieving CR than intravenous (i.v.) cyclophosphamide, mycophenolate mofetil 
      (MMF), oral cyclophosphamide, leflunomide, chlorambucil, azathioprine, and 
      plaebo/nontreatment (P/NT), and more efficacious than i.v. cyclophosphamide, oral 
      cyclophosphamide, and P/NT in terms of TR outcomes. Cyclosporin was associated 
      with a greater CR rate than i.v. cyclophosphamide, MMF, oral cyclophosphamide, 
      chlorambucil, azathioprine, or P/NT, and associated with a greater TR rate than 
      i.v. cyclophosphamide, oral cyclophosphamide, or P/NT. MMF was found to be more 
      efficacious than i.v. cyclophosphamide and oral cyclophosphamide in terms of TR. 
      CONCLUSIONS: Tacrolimus and cyclosporine may be preferred initial treatments for 
      children with SRNS. MMF may be another option for this patient population. 
      Further studies of the efficacy and safety of these three drugs in children with 
      SRNS should be pursued.
FAU - Li, Shaojun
AU  - Li S
AD  - Department of Emergency, Children's Hospital of Chongqing Medical University, 
      Chongqing, China.
AD  - Ministry of Education Key Laboratory of Child Development and Disorders, 
      Chongqing, China.
FAU - Yang, Haiping
AU  - Yang H
AD  - Department of Nephrology, Children's Hospital of Chongqing Medical University, 
      Chongqing, China.
AD  - Chongqing International Science and Technology Cooperation Center for Child 
      Development and Disorders, Chongqing, China.
FAU - Guo, Pengfei
AU  - Guo P
AD  - Department of Emergency, Children's Hospital of Chongqing Medical University, 
      Chongqing, China.
AD  - Ministry of Education Key Laboratory of Child Development and Disorders, 
      Chongqing, China.
FAU - Ao, Xiaoxiao
AU  - Ao X
AD  - Department of Emergency, Children's Hospital of Chongqing Medical University, 
      Chongqing, China.
AD  - Key Laboratory of Pediatrics in Chongqing, Chongqing, China.
FAU - Wan, Junli
AU  - Wan J
AD  - Department of Nephrology, Children's Hospital of Chongqing Medical University, 
      Chongqing, China.
AD  - Key Laboratory of Pediatrics in Chongqing, Chongqing, China.
FAU - Li, Qiu
AU  - Li Q
AD  - Department of Emergency, Children's Hospital of Chongqing Medical University, 
      Chongqing, China.
AD  - Department of Nephrology, Children's Hospital of Chongqing Medical University, 
      Chongqing, China.
AD  - Ministry of Education Key Laboratory of Child Development and Disorders, 
      Chongqing, China.
FAU - Tan, Liping
AU  - Tan L
AD  - Department of Emergency, Children's Hospital of Chongqing Medical University, 
      Chongqing, China.
AD  - Key Laboratory of Pediatrics in Chongqing, Chongqing, China.
LA  - eng
PT  - Journal Article
DEP - 20170821
PL  - United States
TA  - Oncotarget
JT  - Oncotarget
JID - 101532965
PMC - PMC5641191
OTO - NOTNLM
OT  - SRNS
OT  - immunosuppressant
OT  - multiple-treatments meta-analysis
OT  - pediatrics
COIS- CONFLICTS OF INTEREST The authors declare no conflicts of interest concerning 
      this article.
EDAT- 2017/10/27 06:00
MHDA- 2017/10/27 06:01
PMCR- 2017/09/22
CRDT- 2017/10/27 06:00
PHST- 2017/06/21 00:00 [received]
PHST- 2017/08/07 00:00 [accepted]
PHST- 2017/10/27 06:00 [entrez]
PHST- 2017/10/27 06:00 [pubmed]
PHST- 2017/10/27 06:01 [medline]
PHST- 2017/09/22 00:00 [pmc-release]
AID - 20377 [pii]
AID - 10.18632/oncotarget.20377 [doi]
PST - epublish
SO  - Oncotarget. 2017 Aug 21;8(42):73050-73062. doi: 10.18632/oncotarget.20377. 
      eCollection 2017 Sep 22.