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Abstract: PO1889

Efficacy and Safety of Immunosuppressive Therapy in Primary FSGS: A Systematic Review and Meta-Analysis

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Caster, Dawn J., University of Louisville School of Medicine, Louisville, Kentucky, United States
  • Magalhaes, Barbara, LatticePoint Consulting, Geneva, Switzerland
  • Pennese, Natali, LatticePoint Consulting, Geneva, Switzerland
  • Zaffalon, Andrea, LatticePoint Consulting, Geneva, Switzerland
  • Faiella, Marina, LatticePoint Consulting, Geneva, Switzerland
  • Campbell, Kirk N., Icahn School of Medicine at Mount Sinai, New York, New York, 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

Focal segmental glomerulosclerosis (FSGS) is a rare condition which can lead to decline in renal function and progression to ESRD. Immunosuppressants (IS) are often used to treat primary FSGS. However, their efficacy and safety is not clearly established. The objective of this work was to assess the current knowledge on the clinical effectiveness and safety of IS in the treatment of primary FSGS.

Methods

MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials were searched for English-language studies on primary FSGS from inception to 2019. Clinical outcomes of interest were changes from baseline in proteinuria, and renal function (eGFR or CrCl) and survival (ESRD, renal failure, doubling of creatinine, or author reported). When possible, study results were summarized using random effects models as Ratio of Means (ROM) between follow-up and baseline measurements or as Hazard Ratio (HR).

Results

We included 100 articles. Substantial heterogeneity was observed in patient baseline characteristics and study design. Most studies assessed treatment with corticosteroids alone or combined with other drugs, mainly other IS. On average, patients treated with IS showed a reduction of proteinuria (14 studies, ROM=0.34; 95% CI 0.25-0.46). Pooled studies showed a lower CrCl at the end of the follow-up compared to baseline (ROM=0.77; 95% CI 0.71-0.83). In contrast, eGFR measurements suggested no change from baseline to follow-up (16 studies, ROM=0.92; 95% CI 0.84-1.01). IS therapy had uncertain effect on reducing the risk of reaching ESRD (HR=0.79; 95% CI 0.47-1.32). Hypertension and infections were the most commonly reported AEs.

Conclusion

This systematic literature review supports that patients treated with IS have on average, a reduction in proteinuria between baseline and varying follow-up periods. Reported changes from baseline to follow-up in CrCl and eGFR are contrasting and effect of IS on renal survival is uncertain. However, due to lack of properly controlled studies, it is hard to attribute how much of these outcome are due to IS treatment effect, stressing the low certainty evidence currently available in the literature and the need for better designed studies to reliably assess the effect of IS on primary FSGS patients.

Funding

  • Commercial Support