ACTH Treatment for Management of Nephrotic Syndrome: A Systematic Review and Reappraisal.
Journal
International journal of nephrology
ISSN: 2090-214X
Titre abrégé: Int J Nephrol
Pays: United States
ID NLM: 101546753
Informations de publication
Date de publication:
2020
2020
Historique:
received:
06
02
2020
revised:
07
04
2020
accepted:
29
04
2020
entrez:
23
6
2020
pubmed:
23
6
2020
medline:
23
6
2020
Statut:
epublish
Résumé
In recent years, the use of adrenocorticotropic hormone (ACTH) therapy for treatment of proteinuria due to nephrotic syndrome (NS) has been heavily explored. ACTH therapy, which comes in the natural (H. P. Acthar Gel) or synthetic (tetracosactide) form, has resulted in remission in patients with immunosuppressive and steroid-resistant NS. However, the exact efficacy of ACTH therapy in the NS etiologies, such as membranous nephropathy (MN), focal segmental glomerulosclerosis (FSGS), minimal change disease (MCD), lupus nephritis (LN), IgA nephropathy (IgAN), and membranoproliferative glomerulonephritis (MPGN), has not been determined. This systematic review analyzed the published literature on ACTH therapy in various NS etiologies to determine its efficacy. A comprehensive search of MEDLINE, EMBASE, and Cochrane databases was conducted for articles through June 2019. An additional search was performed on clinicaltrials.gov to search for additional trials and cross reference the results of our database search. The literature which studied synthetic or natural ACTH treatment in patients with known etiologies of NS was included. Studies were excluded when they consisted of a single case report or did not analyze the lone effect of ACTH in NS. The initial search yielded a total of 411 papers, and 22 papers were included. In 214 MN patients, there was an overall remission of 40% (85/214) and an overall remission of 43% (42/98) in FSGS patients. In other etiologies, there were overall remissions of 78% (11/14), 31% (5/16), 40% (16/40), and 62% (8/13) in MCD, LN, IgAN, and MPGN patients, respectively. ACTH showed benefits in proteinuria reduction across all etiologies of NS. However, more randomized controlled studies with larger population sets and longer follow-ups are imperative to establish causal benefits. New studies into its efficacy in children are also necessary.
Sections du résumé
BACKGROUND
BACKGROUND
In recent years, the use of adrenocorticotropic hormone (ACTH) therapy for treatment of proteinuria due to nephrotic syndrome (NS) has been heavily explored. ACTH therapy, which comes in the natural (H. P. Acthar Gel) or synthetic (tetracosactide) form, has resulted in remission in patients with immunosuppressive and steroid-resistant NS. However, the exact efficacy of ACTH therapy in the NS etiologies, such as membranous nephropathy (MN), focal segmental glomerulosclerosis (FSGS), minimal change disease (MCD), lupus nephritis (LN), IgA nephropathy (IgAN), and membranoproliferative glomerulonephritis (MPGN), has not been determined.
OBJECTIVE
OBJECTIVE
This systematic review analyzed the published literature on ACTH therapy in various NS etiologies to determine its efficacy.
METHODS
METHODS
A comprehensive search of MEDLINE, EMBASE, and Cochrane databases was conducted for articles through June 2019. An additional search was performed on clinicaltrials.gov to search for additional trials and cross reference the results of our database search. The literature which studied synthetic or natural ACTH treatment in patients with known etiologies of NS was included. Studies were excluded when they consisted of a single case report or did not analyze the lone effect of ACTH in NS.
RESULTS
RESULTS
The initial search yielded a total of 411 papers, and 22 papers were included. In 214 MN patients, there was an overall remission of 40% (85/214) and an overall remission of 43% (42/98) in FSGS patients. In other etiologies, there were overall remissions of 78% (11/14), 31% (5/16), 40% (16/40), and 62% (8/13) in MCD, LN, IgAN, and MPGN patients, respectively.
CONCLUSION
CONCLUSIONS
ACTH showed benefits in proteinuria reduction across all etiologies of NS. However, more randomized controlled studies with larger population sets and longer follow-ups are imperative to establish causal benefits. New studies into its efficacy in children are also necessary.
Identifiants
pubmed: 32566293
doi: 10.1155/2020/2597079
pmc: PMC7292987
doi:
Types de publication
Journal Article
Langues
eng
Pagination
2597079Informations de copyright
Copyright © 2020 Ronith Chakraborty et al.
Déclaration de conflit d'intérêts
The authors declare no conflicts of interest.
Références
BMC Nephrol. 2016 Mar 31;17:37
pubmed: 27036111
J Am Soc Nephrol. 2010 Aug;21(8):1290-8
pubmed: 20507942
Metabolism. 2006 Aug;55(8):1083-7
pubmed: 16839845
Clin J Am Soc Nephrol. 2013 Dec;8(12):2072-81
pubmed: 24009220
Am J Kidney Dis. 2006 Feb;47(2):233-40
pubmed: 16431252
Kidney Int Rep. 2017 Jun 06;2(5):924-932
pubmed: 29270498
F1000Res. 2015 Oct 23;4:1103
pubmed: 27158444
Nat Biotechnol. 2012 Jan 09;30(1):69-77
pubmed: 22231104
Nephrol Dial Transplant. 2004 May;19(5):1305-7
pubmed: 15102969
Clin J Am Soc Nephrol. 2016 Mar 7;11(3):386-94
pubmed: 26912551
Nephrol Dial Transplant. 2014 Aug;29(8):1570-7
pubmed: 24714414
J Am Soc Nephrol. 2017 Jan;28(1):348-358
pubmed: 27352623
Kidney Int Suppl (2011). 2012 Jun;2(2):177-180
pubmed: 25018930
Drug Des Devel Ther. 2011 Mar 14;5:147-53
pubmed: 21448451
Adv Chronic Kidney Dis. 2014 Mar;21(2):134-51
pubmed: 24602463
Int Med Case Rep J. 2016 Jun 28;9:125-33
pubmed: 27418857
Clin Nephrol. 2004 Nov;62(5):403-4
pubmed: 15571191
Am J Nephrol. 2012;36(1):58-67
pubmed: 22722778
Clin Kidney J. 2014 Jun;7(3):293-5
pubmed: 25852892
J Nephrol. 2017 Feb;30(1):35-44
pubmed: 27084801
Clin Nephrol. 2009 Jun;71(6):637-42
pubmed: 19473632
Nat Rev Nephrol. 2011 Dec 06;8(2):122-8
pubmed: 22143333
Transplantation. 2019 Jan;103(1):202-209
pubmed: 29894413
N Engl J Med. 2019 Jul 4;381(1):36-46
pubmed: 31269364
PLoS One. 2015 Nov 12;10(11):e0142033
pubmed: 26562836
Clin J Am Soc Nephrol. 2017 Feb 7;12(2):332-345
pubmed: 27940460
Am J Kidney Dis. 2008 Oct;52(4):699-705
pubmed: 18585835
J Clin Pharmacol. 2016 Feb;56(2):195-202
pubmed: 26120075
Kidney Int Rep. 2020 Mar 03;5(3):382
pubmed: 32154464
Am J Nephrol. 2013;37(1):84-90
pubmed: 23343906
Int J Nephrol Renovasc Dis. 2015 Feb 05;8:7-12
pubmed: 25709493
Cochrane Database Syst Rev. 2011 Mar 16;(3):CD003962
pubmed: 21412884
Cochrane Database Syst Rev. 2014 Oct 16;(10):CD004293
pubmed: 25318831
Arthritis Rheumatol. 2014 Nov;66(11):3096-104
pubmed: 25403681
Kidney Int. 1999 Oct;56(4):1534-43
pubmed: 10504505
Lupus. 2014 Aug;23(9):905-12
pubmed: 24795067