Summary of findings 1. Immunosuppressive treatment versus placebo/no treatment/non‐immunosuppressive supportive treatment.
| Immunosuppressive treatment versus placebo/no treatment/non‐immunosuppressive supportive treatment for primary membranous nephropathy in adults with nephrotic syndrome | |||||
| Patient or population: primary membranous nephropathy in adults with nephrotic syndrome Setting: primary care Intervention: immunosuppressive treatment Comparison: control (placebo/no treatment/non‐immunosuppressive supportive treatment) | |||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | No. of participants (studies) | Certainty of the evidence (GRADE) | |
| Risk with control | Risk with immunosuppressive treatment | ||||
| Death at final follow‐up (range: 9 months to 12 years) |
40 per 1000 | 30 per 1000 (14 to 64) | RR 0.73 (0.34 to 1.59) | 944 (16) | ⊕⊕⊕⊖ Moderate1 |
| End‐stage kidney disease at final follow‐up (range: 9 months to 12 years) |
124 per 1000 | 73 per 1000 (43 to 123) | RR 0.59 (0.35 to 0.99) | 944 (16) | ⊕⊕⊕⊖ Moderate1 |
| Total remission (complete or partial) at final follow‐up (range: 6 months to 12 years) |
337 per 1000 | 485 per 1000 (355 to 663) | RR 1.44 (1.05 to 1.97) | 879 (16) | ⊕⊕⊕⊖ Moderate1 |
| Complete remission at final follow‐up (range: 6 months to 12 years) | 127 per 1000 | 216 per 1000 (133 to 349) | RR 1.70 (1.05 to 2.75) | 879 (16) | ⊕⊕⊕⊖ Moderate1 |
| Recurrence of disease (relapse) at final follow‐up (range: 21 months to 12 years) |
114 per 1000 | 181 per 1000 (102 to 316) |
RR 1.73 (1.05 to 2.86) |
310 (3) | ⊕⊕⊖⊖ Low1,2 |
| 100% increase in serum creatinine at final follow‐up (range: 12 months to 12 years) |
299 per 1000 | 138 per 1000 (78 to 240) |
RR 0.46 (0.26 to 0.80) |
447 (8) | ⊕⊕⊕⊖ Moderate1 |
| Adverse events: temporary/permanent discontinuation or hospitalisation at final follow‐up (range: 6 months to 12 years) |
2 per 1000 | 13 per 1000 (5 to 31) | RR 5.33 (2.19 to 12.98) | 927 (16) | ⊕⊕⊕⊖ Moderate1 |
| Adverse events: infection at 3 years | 54 per 1000 | 159 per 1000 (37 to 682) |
RR 2.95 (0.69 to 12.61) |
106 (1) | ⊕⊖⊖⊖ Very low1,3 |
| Adverse events: malignancy at final follow‐up (range: 17 months to 3 years) |
13 per 1000 | 14 per 1000 (2 to 120) |
RR 1.03 (0.12 to 9.14) |
182 (2) | ⊕⊖⊖⊖ Very Low1,3 |
| *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 Downgraded one level: studies generally unclear or high risk of bias for many domains
2Downgraded one level: serious imprecision ‐ due few events and participants in the included studies
3 Downgraded two levels: very serious imprecision ‐ only one study and very wide confidence intervals indicating appreciable benefit and harm
4Downgraded one level: serious imprecision ‐ very wide confidence intervals indicating appreciable benefit and harm