Summary of findings 4. Cyclosporin versus mycophenolate mofetil with pulse dexamethasone for idiopathic steroid‐resistant nephrotic syndrome in children.
| Cyclosporin versus mycophenolate mofetil with pulse dexamethasone for idiopathic steroid‐resistant nephrotic syndrome in children | |||||
| Patient or population: idiopathic steroid‐resistant nephrotic syndrome in children Setting: paediatric nephrology services Intervention: cyclosporin Comparison: mycophenolate mofetil with pulse dexamethasone (MMF + IV DEXA) | |||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | No. of participants (studies) | Certainty of the evidence (GRADE) | |
| Risk with MMF + IV DEXA | Risk with cyclosporin | ||||
| Treatment response at 52 weeks: complete remission (primary outcome 1, 2) | 91 per 1,000 | 195 per 1,000 (79 to 476) | RR 2.14 (0.87 to 5.24) | 138 (1) | ⊕⊕⊕⊝ MODERATE 1 |
| Treatment response at 52 weeks: partial remission (primary outcome 3) | 242 per 1,000 | 264 per 1,000 (148 to 468) | RR 1.09 (0.61 to 1.93) | 138 (1) | ⊕⊕⊕⊝ MODERATE 1 |
| Sustainable remission between 52 and 78 weeks: complete or partial remission (primary outcome 1, 2, 3) | 333 per 1,000 | 460 per 1,000 (300 to 700) | RR 1.38 (0.90 to 2.10) | 138 (1) | ⊕⊕⊕⊝ MODERATE 1 |
| CKD or death: death by 52 weeks | 30 per 1,000 | 5 per 1,000 (0 to 114) | RR 0.18 (0.01 to 3.75) | 138 (1) | ⊕⊕⊝⊝ LOW 1 2 |
| CKD or death: 50% decline in GFR by 78 weeks | 30 per 1,000 | 69 per 1,000 (14 to 346) | RR 2.29 (0.46 to 11.41) | 138 (1) | ⊕⊕⊝⊝ LOW 1 2 |
| Adverse events (weeks 0 to 26): serious infection requiring hospitalisation | 106 per 1,000 | 69 per 1,000 (23 to 208) | RR 0.65 (0.22 to 1.96) | 138 (1) | ⊕⊕⊝⊝ LOW 1 2 |
| Adverse events (weeks 0 to 26): hypertension | 91 per 1,000 | 153 per 1,000 (60 to 390) | RR 1.68 (0.66 to 4.29) | 138 (1) | ⊕⊕⊝⊝ LOW 1 2 |
| *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 Inadequate enrolment lead to uncertainty in results
2 Few events in study groups