Researchers examine immunosuppressant therapy for focal segmental glomerulosclerosis
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Among patients with focal segmental glomerulosclerosis, immunosuppressant therapy reduced proteinuria but showed no certain impact on kidney function.
Further, researchers called for more randomized controlled trials to explore immunosuppressant therapy in patients with focal segmental glomerulosclerosis (FSGS).
“FSGS is a histologic pattern of glomerular injury resulting from heterogeneous clinicopathology entities and can lead to decline in kidney function and progression to chronic kidney failure. Steroids and other immunosuppressive drugs are often used to treat primary FSGS patients suffering from nephrotic syndrome,” Dawn J. Caster, MD, from the University of Louisville School of Medicine in Louisville, Kentucky, and colleagues wrote. “We have performed a systematic literature review and meta-analysis aimed at assessing the clinical effectiveness and safety of immunosuppressants in the treatment of primary FSGS.”
In a systematic review of 98 randomized controlled trials, interventional non-randomized controlled trials, observational studies, retrospective studies and registries, researchers evaluated the impact of immunosuppressant therapy on patients with primary and genetic FSGS. All publications were searched for on April 5, 2019, using Medline, Cochrane, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects and EMBASE databases.
Two investigators screened, extracted and analyzed study data. Researchers used random effects models as ratio of means between follow-up and baseline measurements to summarize some study results.
Researchers observed substantial heterogeneity in patient baseline characteristics and study design. Analyses revealed patients treated with immunosuppressants experienced reduced proteinuria, decreased creatinine clearance and lower eGFR. However, researchers were unable to identify the effect immunosuppressant therapy had on kidney survival or reducing chronic kidney failure. Overall, the most common adverse events reported in the studies were hypertension and infections.
“In conclusion, this systematic literature review highlights the limited evidence currently available in the literature and the need for better designed, adequately controlled studies to reliably assess the effect of immunosuppressants on primary FSGS patients and to evaluate the safety and tolerability of these treatments,” Caster and colleagues wrote. “It also underscores the need for clarity in the definition of ‘primary’ FSGS. Randomized controlled trials with clear entry criteria to identify patients with primary FSGS are needed to adequately evaluate immunosuppressive regimens in the treatment of primary FSGS.”
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