SP177THE SAFETY AND EFFICACY OF GLUCOCORTICOIDS IN IGA NEPHROPATHY: A SYSTEMATIC REVIEW AND META-ANALYSIS
Bibliographic record
Abstract
INTRODUCTION: IgA nephropathy (IgAN) accounts for up to 45% of cases of glomerulonephritis, but there is a lack of consensus for treatment regimens. The effects of glucocorticoid therapy on patient-important outcomes remain uncertain in IgAN despite several trials evaluating their use. We synthesized the efficacy and safety of glucocorticoids in patients with IgAN in a systematic review and meta-analysis. METHODS: We performed a systematic review and meta-analysis of randomized-controlled trials investigating the effects and safety of glucocorticoid therapy in comparison to standard treatment, placebo or non-immunosuppressive pharmacological agents, in patients with IgAN. We searched electronic databases (MEDLINE, EMBASE, and CENTRAL) and the grey literature until March 1, 2018. Two review authors independently screened articles, assessed risk of bias and extracted data. The quality of the body of evidence was assessed using the GRADE framework. RESULTS: Of 2275 potentially relevant articles identified, 13 studies including 1111 patients met our a priori inclusion criteria. Glucocorticoid therapy reduced proteinuria in patients with a baseline <2 g/day (weighted mean difference [WMD]=-0.24 g/day, 95% CI: -0.36 to -0.12), and in patients with baseline proteinuria ≥2 g/day (WMD=-0.76; 95% CI: -0.97 to -0.54). Glucocorticoids reduced the risk of a composite endpoint of end-stage renal disease, doubling of serum creatinine, and 50% reduction in eGFR (RR 0.43; 95% CI: 0.22 to 0.84). The effects of glucocorticoid therapy on adverse events (RR 1.61; 95% CI: 1.00 to 2.59), serious adverse events (RR 2.63, 95% CI: 0.77 to 8.94), and infections (RR 2.94; 95% CI: 0.29 to 29.69) was uncertain due to heterogeneity and few events. CONCLUSIONS: Glucocorticoid therapy may reduce the risk of proteinuria and end-stage renal disease in IgAN patients, however the certainty of the evidence is low. The degree to which glucocorticoid therapy increases the risk of adverse events remains uncertain.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.012 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.012 | 0.023 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".