Clinical and Experimental Nephrology

, Volume 22, Issue 3, pp 562–569 | Cite as

Immunosuppressive therapy for steroid-resistant nephrotic syndrome: a Bayesian network meta-analysis of randomized controlled studies

  • Xinxin Jiang
  • Wei Shen
  • Xiujun Xu
  • Xiaogang Shen
  • Yiwen Li
  • Qiang He
Original article



The purpose of this study was to conduct a meta-analysis examining the efficacy of cyclophosphamide, cyclosporin, and tacrolimus in treating steroid resistant nephrotic syndrome.


Medline, Cochrane, EMBASE, and Google Scholar were searched until May 02, 2017 using the keywords: immunosuppressive therapy, steroid-resistant nephrotic syndrome, cyclophosphamide, cyclosporine A, and tacrolimus. Inclusion criteria were randomized controlled trials (RCTs) including patients with SRNS treated with an immunosuppressive therapy or placebo.


Seven RCTs were included, and the number of patients ranged from 30 to 131. Conventional pair-wise meta-analysis indicated a higher odds of complete or partial remission with tacrolimus as compared to cyclophosphamide [odds ratio (OR) 4.908, 95% confidence interval (CI) 2.278–10.576, P < 0.001], and cyclophosphamide (OR 0.143, 95% CI 0.028–0.721, P = 0.019) and placebo (OR 0.043, 95% CI 0.012–0.157, P < 0.001) were associated with a lower likelihood of complete or partial remission than cyclosporine. Bayesian analysis indicated that tacrolimus and cyclosporine were the best and the second-best agents for inducing a complete or partial remission (rank probability = 0.53 for tacrolimus and 0.46 for cyclosporine).


As compared to cyclophosphamide and cyclosporin, tacrolimus is more effective at inducing remission in patients with SRNS.


Bayesian Cyclophosphamide Cyclosporin Meta-analysis Steroid-resistant nephrotic syndrome Tacrolimus 


Compliance with ethical standards

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Conflict of interest

The authors have declared that no conflict of interest exists.

Funding source

Zhejiang Provincial Natural Science Fund LY17H050008, Zhejiang Provincial Medical Science and Technology Plan Projects 2017KY227.

Supplementary material

10157_2017_1484_MOESM1_ESM.doc (68 kb)
Supplementary material 1 (DOC 67 kb)


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Copyright information

© Japanese Society of Nephrology 2017

Authors and Affiliations

  • Xinxin Jiang
    • 1
  • Wei Shen
    • 1
  • Xiujun Xu
    • 1
  • Xiaogang Shen
    • 1
  • Yiwen Li
    • 1
  • Qiang He
    • 1
  1. 1.Department of Nephrology, Zhejiang Provincial People’s HospitalPeople’s Hospital of Hangzhou Medical CollegeHangzhouPeople’s Republic of China

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