Efficacy and safety of adrenocorticotropic hormone treatment in glomerular diseases: A systematic review and meta-analysis

Wonngarm Kittanamongkolchai, Wisit Cheungpasitporn, Ladan Zand

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background: There is growing evidence that adrenocorticotropic hormone (ACTH) may be effective in treating various forms of glomerular diseases. However, the efficacy of treatment and frequency of adverse effects associated with the use of ACTH in glomerular diseases are unknown. A systematic review and meta-analysis of the literature was performed. Methods: A literature search was performed using Medline, Embase, Google Scholar and the Cochrane Database of Systematic Reviews from inception through 18 July 2015. Studies assessing the efficacy and safety of ACTH treatment in adults with glomerular diseases were included. Results: Of the 343 identified citations, 18 evaluated the drug efficacy and 12 evaluated the adverse effects. The most common glomerular diseases were membranous nephropathy (MN), primary focal segmental glomerulosclerosis (FSGS) and minimal change disease (MCD). The overall rate of complete remission inMNwas 80% at 0-6 months, 69% at >6-12 months, 90% at >12-24 months and 95% beyond 24 months of follow-up. Fifty percent of primary FSGS and MCD patients treated with ACTH were in remission at 6 months, but the relapse rate was high after ACTH discontinuation (17%). Evidence of ACTH efficacy for other glomerular diseaseswas scarce. Edemawas the most commonly reported adverse effect {incidence rate [IR] 0.10 [95% confidence interval (CI) 0.04-0.18]} followed by insomnia [IR 0.08 (95% CI 0.03-0.15)]. The dropout rate due to adverse events was 7%, mostly due to edema and weight gain. Conclusions: ACTH is awell-tolerated therapy and is most promising when treating patients with MN. Theremay be a potential role for ACTH in patients with MCD and FSGS, but data are lacking.

Original languageEnglish (US)
Pages (from-to)387-396
Number of pages10
JournalClinical Kidney Journal
Volume9
Issue number3
DOIs
StatePublished - Jan 1 2016

Fingerprint

Adrenocorticotropic Hormone
Meta-Analysis
Safety
Lipoid Nephrosis
Focal Segmental Glomerulosclerosis
Membranous Glomerulonephritis
Therapeutics
Confidence Intervals
Incidence
Sleep Initiation and Maintenance Disorders
Weight Gain
Edema
Databases
Recurrence
Pharmaceutical Preparations

Keywords

  • ACTH
  • Adverse effects
  • Glomerular diseases
  • Meta-analysis
  • Systematic review

ASJC Scopus subject areas

  • Nephrology
  • Transplantation

Cite this

Efficacy and safety of adrenocorticotropic hormone treatment in glomerular diseases : A systematic review and meta-analysis. / Kittanamongkolchai, Wonngarm; Cheungpasitporn, Wisit; Zand, Ladan.

In: Clinical Kidney Journal, Vol. 9, No. 3, 01.01.2016, p. 387-396.

Research output: Contribution to journalArticle

@article{06fcfa7e19aa490d813a46d3fb2507b3,
title = "Efficacy and safety of adrenocorticotropic hormone treatment in glomerular diseases: A systematic review and meta-analysis",
abstract = "Background: There is growing evidence that adrenocorticotropic hormone (ACTH) may be effective in treating various forms of glomerular diseases. However, the efficacy of treatment and frequency of adverse effects associated with the use of ACTH in glomerular diseases are unknown. A systematic review and meta-analysis of the literature was performed. Methods: A literature search was performed using Medline, Embase, Google Scholar and the Cochrane Database of Systematic Reviews from inception through 18 July 2015. Studies assessing the efficacy and safety of ACTH treatment in adults with glomerular diseases were included. Results: Of the 343 identified citations, 18 evaluated the drug efficacy and 12 evaluated the adverse effects. The most common glomerular diseases were membranous nephropathy (MN), primary focal segmental glomerulosclerosis (FSGS) and minimal change disease (MCD). The overall rate of complete remission inMNwas 80{\%} at 0-6 months, 69{\%} at >6-12 months, 90{\%} at >12-24 months and 95{\%} beyond 24 months of follow-up. Fifty percent of primary FSGS and MCD patients treated with ACTH were in remission at 6 months, but the relapse rate was high after ACTH discontinuation (17{\%}). Evidence of ACTH efficacy for other glomerular diseaseswas scarce. Edemawas the most commonly reported adverse effect {incidence rate [IR] 0.10 [95{\%} confidence interval (CI) 0.04-0.18]} followed by insomnia [IR 0.08 (95{\%} CI 0.03-0.15)]. The dropout rate due to adverse events was 7{\%}, mostly due to edema and weight gain. Conclusions: ACTH is awell-tolerated therapy and is most promising when treating patients with MN. Theremay be a potential role for ACTH in patients with MCD and FSGS, but data are lacking.",
keywords = "ACTH, Adverse effects, Glomerular diseases, Meta-analysis, Systematic review",
author = "Wonngarm Kittanamongkolchai and Wisit Cheungpasitporn and Ladan Zand",
year = "2016",
month = "1",
day = "1",
doi = "10.1093/ckj/sfw045",
language = "English (US)",
volume = "9",
pages = "387--396",
journal = "CKJ: Clinical Kidney Journal",
issn = "2048-8505",
publisher = "Oxford University Press",
number = "3",

}

TY - JOUR

T1 - Efficacy and safety of adrenocorticotropic hormone treatment in glomerular diseases

T2 - A systematic review and meta-analysis

AU - Kittanamongkolchai, Wonngarm

AU - Cheungpasitporn, Wisit

AU - Zand, Ladan

PY - 2016/1/1

Y1 - 2016/1/1

N2 - Background: There is growing evidence that adrenocorticotropic hormone (ACTH) may be effective in treating various forms of glomerular diseases. However, the efficacy of treatment and frequency of adverse effects associated with the use of ACTH in glomerular diseases are unknown. A systematic review and meta-analysis of the literature was performed. Methods: A literature search was performed using Medline, Embase, Google Scholar and the Cochrane Database of Systematic Reviews from inception through 18 July 2015. Studies assessing the efficacy and safety of ACTH treatment in adults with glomerular diseases were included. Results: Of the 343 identified citations, 18 evaluated the drug efficacy and 12 evaluated the adverse effects. The most common glomerular diseases were membranous nephropathy (MN), primary focal segmental glomerulosclerosis (FSGS) and minimal change disease (MCD). The overall rate of complete remission inMNwas 80% at 0-6 months, 69% at >6-12 months, 90% at >12-24 months and 95% beyond 24 months of follow-up. Fifty percent of primary FSGS and MCD patients treated with ACTH were in remission at 6 months, but the relapse rate was high after ACTH discontinuation (17%). Evidence of ACTH efficacy for other glomerular diseaseswas scarce. Edemawas the most commonly reported adverse effect {incidence rate [IR] 0.10 [95% confidence interval (CI) 0.04-0.18]} followed by insomnia [IR 0.08 (95% CI 0.03-0.15)]. The dropout rate due to adverse events was 7%, mostly due to edema and weight gain. Conclusions: ACTH is awell-tolerated therapy and is most promising when treating patients with MN. Theremay be a potential role for ACTH in patients with MCD and FSGS, but data are lacking.

AB - Background: There is growing evidence that adrenocorticotropic hormone (ACTH) may be effective in treating various forms of glomerular diseases. However, the efficacy of treatment and frequency of adverse effects associated with the use of ACTH in glomerular diseases are unknown. A systematic review and meta-analysis of the literature was performed. Methods: A literature search was performed using Medline, Embase, Google Scholar and the Cochrane Database of Systematic Reviews from inception through 18 July 2015. Studies assessing the efficacy and safety of ACTH treatment in adults with glomerular diseases were included. Results: Of the 343 identified citations, 18 evaluated the drug efficacy and 12 evaluated the adverse effects. The most common glomerular diseases were membranous nephropathy (MN), primary focal segmental glomerulosclerosis (FSGS) and minimal change disease (MCD). The overall rate of complete remission inMNwas 80% at 0-6 months, 69% at >6-12 months, 90% at >12-24 months and 95% beyond 24 months of follow-up. Fifty percent of primary FSGS and MCD patients treated with ACTH were in remission at 6 months, but the relapse rate was high after ACTH discontinuation (17%). Evidence of ACTH efficacy for other glomerular diseaseswas scarce. Edemawas the most commonly reported adverse effect {incidence rate [IR] 0.10 [95% confidence interval (CI) 0.04-0.18]} followed by insomnia [IR 0.08 (95% CI 0.03-0.15)]. The dropout rate due to adverse events was 7%, mostly due to edema and weight gain. Conclusions: ACTH is awell-tolerated therapy and is most promising when treating patients with MN. Theremay be a potential role for ACTH in patients with MCD and FSGS, but data are lacking.

KW - ACTH

KW - Adverse effects

KW - Glomerular diseases

KW - Meta-analysis

KW - Systematic review

UR - http://www.scopus.com/inward/record.url?scp=84978946096&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84978946096&partnerID=8YFLogxK

U2 - 10.1093/ckj/sfw045

DO - 10.1093/ckj/sfw045

M3 - Article

AN - SCOPUS:84978946096

VL - 9

SP - 387

EP - 396

JO - CKJ: Clinical Kidney Journal

JF - CKJ: Clinical Kidney Journal

SN - 2048-8505

IS - 3

ER -