ACTH treatment for management of nephrotic syndrome: A systematic review and reappraisal.

Title

ACTH treatment for management of nephrotic syndrome: A systematic review and reappraisal.

Creator

Chakraborty R; Mehta A; Nair N; Nemer L; Jain R; Joshi H; Raina R

Publisher

International Journal of Nephrology

Date

2020
2020-06

Description

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: This systematic review analyzed the published literature on ACTH therapy in various NS etiologies to determine its efficacy. 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: 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: 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.

Subject

DESCRIPTIVE statistics; TREATMENT effectiveness; MEDICAL information storage & retrieval systems; MEDLINE; SYSTEMATIC reviews (Medical research); NEPHROTIC syndrome treatment; ADRENOCORTICOTROPIC hormone; INFORMATION storage & retrieval systems – Medical care

Rights

Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).

Format

journalArticle

Search for Full-text

Users with a NEOMED Library login can search for full-text journal articles at the following url: https://libraryguides.neomed.edu/home

Pages

2597079

Volume

2020

NEOMED College

NEOMED College of Medicine
NEOMED College of Medicine Student

NEOMED Department

Department of Internal Medicine
NEOMED Student Publications

Update Year & Number

July 2020 List

Affiliated Hospital

Cleveland Clinic Akron General Hospital

Citation

Chakraborty R; Mehta A; Nair N; Nemer L; Jain R; Joshi H; Raina R, “ACTH treatment for management of nephrotic syndrome: A systematic review and reappraisal.,” NEOMED Bibliography Database, accessed January 20, 2021, https://neomed.omeka.net/items/show/11147.

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