Safety of ACTH Treatment in Glomerular Diseases: A Meta-Analysis.

Kittanamongkolchai, W.; Cheungpasitporn, W.; Zand, L.

Background: The use Adrenocorticotropic hormone (ACTH) is rising since it received FDA approval as a treatment for proteinuria secondary to nephrotic syndrome. However, the frequency of adverse effects associated with the use of ACTH is unknown. Methods: A literature search was performed using MEDLINE, EMBASE, Google scholar and Cochrane Database from inception through July 18, 2015. Studies assessing safety of ACTH Treatment in adults with glomerular diseases were included. A meta-analysis was conducted to summarize the incidence of adverse effects in this population. We used a random-effects meta-analysis model to estimate the incident rate. Results: Our search strategy yielded 352 potentially relevant articles. There were 12 studies reported adverse effects of ACTH in 171 participants with membranous nephropathy (n = 87), FSGS (n = 30), minimal change disease (n = 8), Ig A nephropathy (n = 12), lupus nephritis (n = 4), diabetic nephropathy (n = 14) and other glomerular diseases (n = 16). Treatment duration ranged from 2 to 48 months. Edema was the most common side effect (incidence rate (IR) 0.10; 95% CI, 0.04-0.18) followed by insomnia (IR 0.08; 95% CI, 0.03-0.15), hyperglycemia (IR 0.07; 95% CI, 0.04-0.11) and mood swings (IR 0.07; 95% CI, 0.02-0.14) (table 1). The dropout rate due to adverse event was 7%, mostly due to edema and weight gain (5 out of 12 patients). No severe adverse reactions or death associated with ACTH injections were reported. Conclusions: ACTH therapy in glomerular diseases is overall well-tolerated and has a more favorable side effect profile than corticosteroids.

ADRENOCORTICOTROPIC hormone; KIDNEY disease treatments; UNITED States. Food & Drug Administration; DRUG approval; PROTEINURIA treatment; THERAPEUTICS

Blood Purification, 2016, Vol 41, Issue 1-3, p225

0253-5068

Academic Journal

10.1159/000442341