Comparative Effectiveness And Tolerance Of Different Medications For Primary Focal Segmental Glomerulosclerosis:A Bayesian Network Meta-analysis Of Randomized Controlled Studies

Purpose:We searched the most reliable data of RCTs to performed a network meta-analysis evaluated the efficacy and safety of different medications in patients with FSGS,and to ranked the results in the hope of providing sufficient reference information for clinical treatment.Methods:Cochrane library,Medline,Embase,Web of Science,Pubmed,Chinese Biomedical Literature Database(CBM),China Science and Technology Journal Database,China National Knowledge Infrastructure(CNKI),WangFang Datebase were searched for RCTs reporting the treatments for FSGS.Composite endpoint of efficacy and safety were compared combing direct and indirect comparison using network meta-analysis.Then network meta-analysis was performed using ADDIS and Stata 12.0 software for statistical analysis.Results:Total 23 RCTs(n=1097)covering 14 kinds of treatments were included.1.Effectiveness:(1)Conventional meta-analysis:General meta-analysis results indicated a higher rate of total remission with Cyclosporin A(CsA)[OR(95%CI)2.21(1.454,3.09)]as compared to Mycophenolate mofetil(MMF),cyclophosphamide(CTX),Glucocorticoid(GC)and placebo.TAC and MMF significantly reduced the level of urinary protein,and its MD(95%CI)was-1.023(-1.754,-0.292)and-5.388(-6.97,-3.806),respectively;TAC significantly reduced serum creatinine levels,with MD(95%CI)of 1.654(0.854,2.453);CsA and MMF significantly increased albumin levels,with MD(95%CI)of 1.064(0.416,1.713)and 1.48(0.666,1.294),respectively,compared with the CTX group.As compared to TAC,MMF[MD(95%CI)-2.377(-3.185,-1.569)]group were more likely to reduced cholesterol levels.(2)Bayesian network meta-analysis(NMAs):As compared to other drugs,TAC(rank=0.53)and CsA(rank=0.49)indicated a higher rate of total remission;MMF group were better to reduce the level of urinary protein(rank=0.46)and cholesterol(rank= 0.39).CTX(rank=0.60)group were better to reduce serum creatinine levels;CTX group were better on increasing albumin(rank=0.51).2.Safety:(1)Conventional meta-analysis:TAC、CsA、MMF、CTX and GC can cause infection and elevated blood pressure levels,there was no significant statistical differences(P>0.05).TAC significantly reduced the risk of developing gastrointestinal reactions,with the OR(95%CI)were 1.673(1.094,2.560);CSA more likely to change your face,more likely to change your face,with the OR(95%CI)were 0.049(0.003,0.766)compared with the CSA group.Control、CsA、CTX and TAC group can elevated transaminases,there was no significant statistical differences(P>0.05).(2)Bayesian network meta-analysis(NMAs):As compared to other drugs,TAC(rank=0.02)and CsA(rank=0.02)indicated a lower risk of infection;Placeo group were less likely to elevated blood pressure levels(rank=0.45);Control group was less likely to have gastrointestinal reactions(rank=0.83);TAC group was less likely to change your face(rank=0.92);MMF(rank=0.39)was less likely to damage liver function.Conclusion:TAC and CsA may be preferred initial treatments for FSGS with better remission rate.Moreover,as compared to CsA,TAC is more effective at inducing remission in patients with FSGS.TAC may be another option for this patient population.Further studies of the efficacy of the drugs in FSGS should be pursued.These data can help patients make informed decisions about treatment options for FSGS.