| Abstract [eng] |
Aim of the study: To compare the efficacy and safety of immunosuppressive medications used for treatment of childhood nephrotic syndrome. Study methods: A search was conducted in the PubMed database for relevant trials about efficacy and safety of immunosupressive treatment for pediatric nephrotic syndrome performed and published in international scientific literature in English between 2012–2022. Results: A total of 51 trials were identified based on preset criteria. Tacrolimus was the most effective overall, inducing complete or partial remission in 81.3% of all patients. Tacrolimus was also the most effective drug for steroid resistant patients, inducing complete or partial remission in 84.4% of them. Somewhat less effective was cyclosporine A, which was efficacious for 71.8% of steroid resistant patients. Cyclosporine A was the most effective drug in the steroid sensitive patient group, its overall efficacy was 87.0% of those treated. Other effective drugs among steroid sensitive patients were cyclophosphamide and rituximab – using them 80.9% and 79.4% of patients respectively attained remission. In the largest part (66.7%) of steroid sensitive patients the drug, that helped reach remission was mycophenolate mofetil. All drugs described in the trials significantly lowered the relapse rate, however the most significant reduction was observed among patients treated with rituximab – in 8/11 trials with rituximab the relapse rate lowered to <0.5 relapses/year. The highest rate or adverse effects was observed among patients treated with cyclosporine A (55.8 cases/100 children), the lowest – among those treated with levamisole (9.6 cases/100 children). Conclusions: Calcineurin inhibitors, particularly tacrolimus, are the most appropriate medications in treating patients with steroid resistant nephrotic syndrome. For treatment of patients with steroid sensitive nephrotic syndrome some of the most appropriate medications were cyclosporine A, rituximab and others. When choosing treatment it is important to consider not only its efficacy, but also possible adverse effects. |
