Summary of findings for the main comparison. Systemic corticosteroid versus no corticosteroid regimen for IgA nephropathy.
| Systemic corticosteroid versus no corticosteroid regimen for IgA nephropathy | |||||
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Patient or population: adults and children who have IgA nephropathy proven on renal biopsy Setting: Australia, China, Europe, Japan, USA Intervention: corticosteroid regimen (includes steroids alone or with RAS inhibitors) Comparison: no corticosteroid regimen | |||||
| Outcomes | Anticipated absolute benefits* (95% CI) | Relative effect (95% CI) | No. of participants (studies) | Quality of the evidence (GRADE) | |
| Risk with no steroids | Risk with steroids | ||||
|
End‐stage kidney disease Follow‐up: 2 to 10 years |
141 per 1000 | 55 per 1000 (32 to 92) |
RR 0.39 (0.23 to 0.65) |
741 (8) | ⊕⊕⊕⊝ moderate 1 |
|
Complete remission Follow‐up: 2 to 5 years |
364 per 1000 | 641 per 1000 (375 to 1000) | RR 1.76 (1.03 to 3.01) |
305 (4) | ⊕⊕⊝⊝ low 1,3 |
|
GFR loss ≥ 50% Follow‐up: 2 to 2.1 years |
96 per 1000 | 54 per 1000 (24 to 119) |
RR 0.56 (0.25 to 1.24) |
326 (2) | ⊕⊕⊝⊝ low 1,2 |
|
Annual GFR loss (mL/min/1.73 m2) Follow‐up: 2.1 to 5 years |
The mean annual GFR loss ranged across control groups from 6.17 to 6.95 mL/min/1.73 m2 | The mean annual GFR loss in the intervention group was ‐5.40 mL/min/1.73 m2 less than the control group (95% CI ‐8.55 less to ‐2.25 less) | ‐‐ | 359 (2) | ⊕⊕⊕⊝ moderate 1 |
|
Death (any cause) Median follow‐up: 2.1 years |
8 per 1000 | 15 per 1000 (1 to 162) |
RR 1.85 (0.17 to 20.19) |
262 (1) | ⊕⊝⊝⊝ very low 1,4 |
|
Infection Median follow‐up: 2.1 years |
No events | 11/136** | RR 21.32 (1.27, 358.10) | 262 (1) | ⊕⊝⊝⊝ very low 1,2,3 |
|
Malignancy Follow‐up: 6 years |
23 per 1000 | 23 per 1000 (1 to 356) |
RR 1.00 (0.06 to 15.48) |
86 (1) | ⊕⊝⊝⊝ very low 1,2,4 |
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The risk in the intervention group (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). 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 ** Event rate derived from the raw data. A 'per thousand' rate is non‐informative in view of the scarcity of evidence and zero events in the control group | |||||
| 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 Downgraded due to study limitations including lack of allocation concealment and lack of blinding
2 Downgraded due to imprecision in treatment estimate (consistent with appreciable benefit or harm)
3 Downgraded due to evidence of important statistical heterogeneity
4 Downgraded two levels due to severe imprecision in treatment estimate (consistent with appreciable benefit or harm)