Summary of findings 2. Pulse cyclophosphamide versus continuous cyclophosphamide for remission induction.
| Pulse cyclophosphamide (CPA) versus continuous CPA for remission induction | |||||
| Patient or population: adults with renal vasculitis Settings: inpatients then outpatients Intervention: pulse CPA Comparison: continuous CPA | |||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No. of participants (studies) | Quality of the evidence (GRADE) | |
| Assumed risk | Corresponding risk | ||||
| Continuous CPA | Pulse CPA | ||||
| Death at final follow‐up | 206 per 1000 | 158 per 1000 (90 to 271) | RR 0.77 (0.44 to 1.32) | 278 (4) | ⊕⊕⊝⊝ low1,2 |
| Serum creatinine at 12 months | Mean serum creatinine in the pulse CPA group was 9.78 µmol/L lower (53.16 lower to 33.61 higher) than the continuous CPA group | ‐‐ | 52 (2) | ⊕⊕⊝⊝ low2,3 | |
| Dialysis at end of study | 74 per 1000 | 140 per 1000 (68 to 288) | RR 1.90 (0.92 to 3.91) | 245 (4) | ⊕⊕⊝⊝ low1,2 |
| Remission at 6 months | 880 to 1000 |
906 per 1000 (808 to 994) |
RR 1.03 (0.93 to 1.13) |
176 (2) | ⊕⊕⊝⊝ low1,2 |
| Relapse at the end of follow‐up | 181 per 1000 | 324 per 1000 (201 to 519) | RR 1.79 (1.11 to 2.87) | 235 (4) | ⊕⊕⊝⊝ low1,2 |
| Adverse events ‐ treatment failure | 140 per 1000 |
190 per 1000 (21 to 1000) |
RR 1.36 (0.115 to 12.56) |
82 (2) | ⊕⊕⊝⊝ low1,2 |
| Serious infections | 348 per 1000 | 247 per 1000 (132 to 462) | RR 0.71 (0.38 to 1.33) | 278 (4) | ⊕⊕⊝⊝ low1,4 |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) 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: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | |||||
1 Two of these studies had a high risk of bias. 2 Sample size and/or event rate were low. 3 Wide 95% CI 4 Very different event rates across studies