Summary of findings 6. Oral cyclophosphamide versus prednisone or placebo for idiopathic steroid‐resistant nephrotic syndrome in children.
| Oral cyclophosphamide versus prednisone/placebo for idiopathic steroid‐resistant nephrotic syndrome in children | |||||
| Patient or population: idiopathic steroid‐resistant nephrotic syndrome in children Setting: paediatric nephrology services Intervention: oral cyclophosphamide (CPA) Comparison: prednisone/placebo | |||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | No. of participants (studies) | Certainty of the evidence (GRADE) | |
| Risk with prednisone/placebo | Risk with oral CPA | ||||
| Complete remission: all renal pathologies | 353 per 1,000 | 374 per 1,000 (215 to 660) | RR 1.06 (0.61 to 1.87) | 84 (2) | ⊕⊕⊝⊝ LOW 1 2 |
| Complete remission: FSGS | 250 per 1,000 | 253 per 1,000 (108 to 593) | RR 1.01 (0.43 to 2.37) | 63 (2) | ⊕⊕⊝⊝ LOW 1 2 |
| Complete or partial remission | 571 per 1,000 | 503 per 1,000 (303 to 829) | RR 0.88 (0.53 to 1.45) | 53 (1) | ⊕⊕⊝⊝ LOW 1 2 |
| Complete or partial remission: FSGS | 571 per 1,000 | 503 per 1,000 (303 to 829) | RR 0.88 (0.53 to 1.45) | 53 (1) | ⊕⊕⊝⊝ LOW 1 2 |
| Treatment failure | 360 per 1,000 | 572 per 1,000 (313 to 1,000) | RR 1.59 (0.87 to 2.88) | 60 (1) | ⊕⊕⊝⊝ LOW 1 2 |
| Adverse events: death (all causes) | 80 per 1,000 | 86 per 1,000 (15 to 476) | RR 1.07 (0.19 to 5.95) | 60 (1) | ⊕⊕⊝⊝ LOW 1 2 |
| Adverse events: hypertension with seizures | 40 per 1,000 | 28 per 1,000 (2 to 436) | RR 0.71 (0.05 to 10.89) | 60 (1) | ⊕⊝⊝⊝ VERY 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; FSGS: focal segmental glomerulosclerosis | |||||
| 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 Serious risk of bias issues. Unclear sequence generation and allocation concealment. Attrition bias
2 Small number of included participants