Summary of findings 3.
Cyclosporin versus mycophenolate mofetil with dexamethasone
| Interventions for idiopathic steroid‐resistant nephrotic syndrome in children | ||||||
| Patient or population: idiopathic steroid‐resistant nephrotic syndrome in children Setting: Paediatric and adult nephrology clinics Intervention: cyclosporin Comparison: mycophenolate mofetil with pulse dexamethasone | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | No. of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Risk with mycophenolate mofetil with pulse dexamethasone | Risk with Cyclosporin | |||||
| Remission at 52 weeks: complete remission (primary outcome 1,2) | Study population | RR 2.14 (0.87 to 5.24) | 138 (1) | ⊕⊕⊕⊝ MODERATE 1 | ||
| 91 per 1000 | 195 per 1000 (79 to 476) | |||||
| Moderate | ||||||
| 91 per 1000 | 195 per 1000 (79 to 476) | |||||
| Remission at 52 weeks: complete or partial remission (primary outcome 1,2,3) | Study population | RR 1.38 (0.90 to 2.10) | 138 (1) | ⊕⊕⊕⊝ MODERATE 1 | ||
| 333 per 1000 | 460 per 1000 (300 to 700) | |||||
| Moderate | ||||||
| 333 per 1000 | 460 per 1000 (300 to 700) | |||||
| CKD or death: death by 52 weeks | Study population | RR 0.18 (0.01 to 3.75) | 138 (1) | ⊕⊕⊕⊝ MODERATE 1 | ||
| 30 per 1000 | 5 per 1000 (0 to 114) | |||||
| Moderate | ||||||
| 30 per 1000 | 5 per 1000 (0 to 114) | |||||
| CKD or death: 50% decline in GFR by 78 weeks | Study population | RR 2.29 (0.46 to 11.41) | 138 (1) | ⊕⊕⊕⊝ MODERATE 1 | ||
| 30 per 1000 | 69 per 1000 (14 to 346) | |||||
| Moderate | ||||||
| 30 per 1000 | 69 per 1000 (14 to 346) | |||||
| Adverse effects (weeks 0 to 26): serious infection requiring hospitalisation | Study population | RR 0.65 (0.22 to 1.96) | 138 (1) | ⊕⊕⊕⊝ MODERATE 1 | ||
| 106 per 1000 | 69 per 1000 (23 to 208) | |||||
| Moderate | ||||||
| 106 per 1000 | 69 per 1000 (23 to 208) | |||||
| Adverse effects (weeks 0 to 26): neuropsychiatric conditions | Study population | RR 1.26 (0.73 to 2.19) | 138 (1) | ⊕⊕⊕⊝ MODERATE 1 | ||
| 242 per 1000 | 305 per 1000 (177 to 531) | |||||
| Moderate | ||||||
| 242 per 1000 | 305 per 1000 (177 to 531) | |||||
| Adverse effects (weeks 0 to 26): hypertension | Study population | RR 1.68 (0.66 to 4.29) | 138 (1) | ⊕⊕⊕⊝ MODERATE 1 | ||
| 91 per 1000 | 153 per 1000 (60 to 390) | |||||
| Moderate | ||||||
| 91 per 1000 | 153 per 1000 (60 to 390) | |||||
| *The risk in the intervention group (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio | ||||||
| GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | ||||||
1 Insufficient recruitment to exclude difference between treatments