Summary of findings 2. Calcineurin inhibitor versus IV cyclophosphamide for idiopathic steroid‐resistant nephrotic syndrome in children.
| Calcineurin inhibitor versus IV cyclophosphamide for idiopathic steroid‐resistant nephrotic syndrome in children | |||||
| Patient or population: idiopathic steroid‐resistant nephrotic syndrome in children Setting: paediatric nephrology services Intervention: calcineurin inhibitor (CNI) Comparison: IV cyclophosphamide (CPA) | |||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | No. of participants (studies) | Certainty of the evidence (GRADE) | |
| Risk with IV CPA | Risk with CNI | ||||
| Treatment response at 3 to 6 months: complete or partial remission | 397 per 1,000 | 787 per 1,000 (497 to 1,000) | RR 1.98 (1.25 to 3.13) | 156 (2) | ⊕⊕⊝⊝ LOW 1 2 |
| Treatment response at 3 to 6 months: complete remission | 128 per 1,000 | 440 per 1,000 (236 to 822) | RR 3.43 (1.84 to 6.41) | 156 (2) | ⊕⊕⊝⊝ LOW 1 2 |
| Treatment response at 3 to 6 months: partial remission | 269 per 1,000 | 452 per 1,000 (116 to 1,000) | RR 1.68 (0.43 to 6.56) | 156 (2) | ⊕⊝⊝⊝ VERY LOW 1 2 3 |
| Adverse events: treatment failure at 6 months (non response, serious infection, persistently elevated creatinine) | 541 per 1,000 | 173 per 1,000 (97 to 314) | RR 0.32 (0.18 to 0.58) | 124 (1) | ⊕⊕⊕⊝ MODERATE 2 |
| Adverse events: medications ceased due to adverse events | 154 per 1,000 | 31 per 1,000 (6 to 132) | RR 0.20 (0.04 to 0.86) | 131 (1) | ⊕⊕⊕⊝ MODERATE 2 |
| Adverse events: serious infections | 123 per 1,000 | 60 per 1,000 (20 to 192) | RR 0.49 (0.16 to 1.56) | 131 (1) | ⊕⊕⊕⊝ MODERATE 2 |
| Adverse events: death | 15 per 1,000 | 5 per 1,000 (0 to 122) | RR 0.33 (0.01 to 7.92) | 131 (1) | ⊕⊕⊝⊝ LOW 4 |
| *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 certainty: We are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: 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 certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | |||||
1 One study at high risk of attrition bias
2 Small numbers of patients included in studies
3 Significant heterogeneity between studies
4 Few events in singles study