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Abstract: PO1888

Efficacy and Safety of ACE Inhibitor and ARB Therapies in Primary FSGS Treatment: A Systematic Review and Meta-Analysis

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Campbell, Kirk N., Mt Sinai School of Medicine, New York, New York, United States
  • Pennese, Natali, LatticePoint Consulting, Geneva, Switzerland
  • Zaffalon, Andrea, LatticePoint Consulting, Geneva, Switzerland
  • Magalhaes, Barbara, LatticePoint Consulting, Geneva, Switzerland
  • Faiella, Marina, LatticePoint Consulting, Geneva, Switzerland
  • Caster, Dawn J., University of Louisville School of Medicine, Louisville, Kentucky, United States
  • Radhakrishnan, Jai, Columbia University Medical Center, New York, New York, United States
  • Tesar, Vladimir, Charles University, General University Hospital, Prague, Czechia
  • Trachtman, Howard, NYU School of Medicine, NYU Langone Medical Center, New York, New York, United States
Background

Use of ACEi and/or ARB (RASi) as conservative management to control proteinuria in primary and genetic focal segmental glomerulosclerosis (FSGS) follows guideline recommendations based on other proteinuria-related kidney diseases. There is lack of consensus about the efficacy and safety of RASi therapies in primary and genetic FSGS, thus this systematic review aims to assess the benefits and risks of RASi therapies on renal outcomes in these patients.

Methods

English-language studies were searched in MEDLINE, Embase and Cochrane Central Register of Controlled Trials, from inception to April 2019. Cohort studies assessing efficacy (response to treatment and indicators of renal function) and safety outcomes in primary and genetic FSGS were selected. Study results were summarized as Ratio of Means (ROM) between baseline and follow-up measurements, or as Hazard Ratio (HR) using random effects models.

Results

We selected 30 studies of which only 5 were controlled trials. Only 8 assessed RASi as monotherapy while the rest studied them in combination with other drugs, mainly immunosuppressants (IS). On average, a 32% reduction on proteinuria (ROM=0.68; 95% CI: 0.47-0.98) and no change on CrCl (ROM=0.95; 95% CI: 0.77-1.16) from baseline to variable follow-up periods was observed in patients treated with RASi therapy alone. A reduction of 72% in proteinuria was observed when RASi were combined with other drugs, mainly IS (ROM=0.24, 95% CI: 0.08-0.75). Published data did not allow to evaluate the eGFR ROM between follow-up and baseline and the effect on the risk of reaching ESRD of RASi therapy alone. Only one controlled study reported adverse effects of RASi as monotherapy. Overall, the available evidence exhibits considerable heterogeneity in cohort baseline characteristics and study design.

Conclusion

This review supports the tendency to observe a reduction of proteinuria in patients treated with RASi, and demonstrates the lack of strong evidence to quantify their effect on eGFR and their long-term impact on renal survival. The current lack of properly controlled studies in primary FSGS stresses the need for larger and better designed clinical trials to better understand the effect of RASi.

Funding

  • Commercial Support