Cargando…
Comparative Efficacy of Pharmacological Treatments for Adults With Autosomal Dominant Polycystic Kidney Disease: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials
Background: Tolvaptan is the gold standard treatment for autosomal dominant polycystic kidney disease (ADPKD), while several other drugs have the potential to inhibit the progression of ADPKD. However, individual clinical trials may not show sufficient differences in clinical efficacy due to small s...
Autores principales: | , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2022
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9158498/ https://www.ncbi.nlm.nih.gov/pubmed/35662736 http://dx.doi.org/10.3389/fphar.2022.885457 |
_version_ | 1784718850495873024 |
---|---|
author | Tsukamoto, Shunichiro Urate, Shingo Yamada, Takayuki Azushima, Kengo Yamaji, Takahiro Kinguchi, Sho Uneda, Kazushi Kanaoka, Tomohiko Wakui, Hiromichi Tamura, Kouichi |
author_facet | Tsukamoto, Shunichiro Urate, Shingo Yamada, Takayuki Azushima, Kengo Yamaji, Takahiro Kinguchi, Sho Uneda, Kazushi Kanaoka, Tomohiko Wakui, Hiromichi Tamura, Kouichi |
author_sort | Tsukamoto, Shunichiro |
collection | PubMed |
description | Background: Tolvaptan is the gold standard treatment for autosomal dominant polycystic kidney disease (ADPKD), while several other drugs have the potential to inhibit the progression of ADPKD. However, individual clinical trials may not show sufficient differences in clinical efficacy due to small sample sizes. Furthermore, the differences in therapeutic efficacy among drugs are unclear. Herein, we investigated the effect of the ADPKD treatments. Methods: We systematically searched PubMed, Medline, EMBASE, and the Cochrane Library through January 2022 to identify randomized controlled trials in ADPKD patients that compared the effects of treatments with placebo or conventional therapy. A network meta-analysis was performed to compare the treatments indirectly. The primary outcomes were changes in kidney function and the rate of total kidney volume (TKV) growth. Results: Sixteen studies were selected with a total of 4,391 patients. Tolvaptan significantly preserved kidney function and inhibited TKV growth compared to the placebo {standardized mean difference (SMD) [95% confidence interval (CI)]: 0.24 (0.16; 0.31) and MD: −2.70 (−3.10; −2.30), respectively}. Tyrosine kinase inhibitors and mammalian target of rapamycin (mTOR) inhibitors inhibited TKV growth compared to the placebo; somatostatin analogs significantly inhibited TKV growth compared to the placebo and tolvaptan [MD: −5.69 (−7.34; −4.03) and MD: −2.99 (−4.69; −1.29), respectively]. Metformin tended to preserve renal function, although it was not significant [SMD: 0.28 (−0.05; 0.61), p = 0.09]. Conclusion: The therapeutic effect of tolvaptan was reasonable as the gold standard for ADPKD treatment, while somatostatin analogs also showed notable efficacy in inhibiting TKV growth. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42022300814. |
format | Online Article Text |
id | pubmed-9158498 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-91584982022-06-02 Comparative Efficacy of Pharmacological Treatments for Adults With Autosomal Dominant Polycystic Kidney Disease: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials Tsukamoto, Shunichiro Urate, Shingo Yamada, Takayuki Azushima, Kengo Yamaji, Takahiro Kinguchi, Sho Uneda, Kazushi Kanaoka, Tomohiko Wakui, Hiromichi Tamura, Kouichi Front Pharmacol Pharmacology Background: Tolvaptan is the gold standard treatment for autosomal dominant polycystic kidney disease (ADPKD), while several other drugs have the potential to inhibit the progression of ADPKD. However, individual clinical trials may not show sufficient differences in clinical efficacy due to small sample sizes. Furthermore, the differences in therapeutic efficacy among drugs are unclear. Herein, we investigated the effect of the ADPKD treatments. Methods: We systematically searched PubMed, Medline, EMBASE, and the Cochrane Library through January 2022 to identify randomized controlled trials in ADPKD patients that compared the effects of treatments with placebo or conventional therapy. A network meta-analysis was performed to compare the treatments indirectly. The primary outcomes were changes in kidney function and the rate of total kidney volume (TKV) growth. Results: Sixteen studies were selected with a total of 4,391 patients. Tolvaptan significantly preserved kidney function and inhibited TKV growth compared to the placebo {standardized mean difference (SMD) [95% confidence interval (CI)]: 0.24 (0.16; 0.31) and MD: −2.70 (−3.10; −2.30), respectively}. Tyrosine kinase inhibitors and mammalian target of rapamycin (mTOR) inhibitors inhibited TKV growth compared to the placebo; somatostatin analogs significantly inhibited TKV growth compared to the placebo and tolvaptan [MD: −5.69 (−7.34; −4.03) and MD: −2.99 (−4.69; −1.29), respectively]. Metformin tended to preserve renal function, although it was not significant [SMD: 0.28 (−0.05; 0.61), p = 0.09]. Conclusion: The therapeutic effect of tolvaptan was reasonable as the gold standard for ADPKD treatment, while somatostatin analogs also showed notable efficacy in inhibiting TKV growth. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42022300814. Frontiers Media S.A. 2022-05-18 /pmc/articles/PMC9158498/ /pubmed/35662736 http://dx.doi.org/10.3389/fphar.2022.885457 Text en Copyright © 2022 Tsukamoto, Urate, Yamada, Azushima, Yamaji, Kinguchi, Uneda, Kanaoka, Wakui and Tamura. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Pharmacology Tsukamoto, Shunichiro Urate, Shingo Yamada, Takayuki Azushima, Kengo Yamaji, Takahiro Kinguchi, Sho Uneda, Kazushi Kanaoka, Tomohiko Wakui, Hiromichi Tamura, Kouichi Comparative Efficacy of Pharmacological Treatments for Adults With Autosomal Dominant Polycystic Kidney Disease: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials |
title | Comparative Efficacy of Pharmacological Treatments for Adults With Autosomal Dominant Polycystic Kidney Disease: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials |
title_full | Comparative Efficacy of Pharmacological Treatments for Adults With Autosomal Dominant Polycystic Kidney Disease: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials |
title_fullStr | Comparative Efficacy of Pharmacological Treatments for Adults With Autosomal Dominant Polycystic Kidney Disease: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials |
title_full_unstemmed | Comparative Efficacy of Pharmacological Treatments for Adults With Autosomal Dominant Polycystic Kidney Disease: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials |
title_short | Comparative Efficacy of Pharmacological Treatments for Adults With Autosomal Dominant Polycystic Kidney Disease: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials |
title_sort | comparative efficacy of pharmacological treatments for adults with autosomal dominant polycystic kidney disease: a systematic review and network meta-analysis of randomized controlled trials |
topic | Pharmacology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9158498/ https://www.ncbi.nlm.nih.gov/pubmed/35662736 http://dx.doi.org/10.3389/fphar.2022.885457 |
work_keys_str_mv | AT tsukamotoshunichiro comparativeefficacyofpharmacologicaltreatmentsforadultswithautosomaldominantpolycystickidneydiseaseasystematicreviewandnetworkmetaanalysisofrandomizedcontrolledtrials AT urateshingo comparativeefficacyofpharmacologicaltreatmentsforadultswithautosomaldominantpolycystickidneydiseaseasystematicreviewandnetworkmetaanalysisofrandomizedcontrolledtrials AT yamadatakayuki comparativeefficacyofpharmacologicaltreatmentsforadultswithautosomaldominantpolycystickidneydiseaseasystematicreviewandnetworkmetaanalysisofrandomizedcontrolledtrials AT azushimakengo comparativeefficacyofpharmacologicaltreatmentsforadultswithautosomaldominantpolycystickidneydiseaseasystematicreviewandnetworkmetaanalysisofrandomizedcontrolledtrials AT yamajitakahiro comparativeefficacyofpharmacologicaltreatmentsforadultswithautosomaldominantpolycystickidneydiseaseasystematicreviewandnetworkmetaanalysisofrandomizedcontrolledtrials AT kinguchisho comparativeefficacyofpharmacologicaltreatmentsforadultswithautosomaldominantpolycystickidneydiseaseasystematicreviewandnetworkmetaanalysisofrandomizedcontrolledtrials AT unedakazushi comparativeefficacyofpharmacologicaltreatmentsforadultswithautosomaldominantpolycystickidneydiseaseasystematicreviewandnetworkmetaanalysisofrandomizedcontrolledtrials AT kanaokatomohiko comparativeefficacyofpharmacologicaltreatmentsforadultswithautosomaldominantpolycystickidneydiseaseasystematicreviewandnetworkmetaanalysisofrandomizedcontrolledtrials AT wakuihiromichi comparativeefficacyofpharmacologicaltreatmentsforadultswithautosomaldominantpolycystickidneydiseaseasystematicreviewandnetworkmetaanalysisofrandomizedcontrolledtrials AT tamurakouichi comparativeefficacyofpharmacologicaltreatmentsforadultswithautosomaldominantpolycystickidneydiseaseasystematicreviewandnetworkmetaanalysisofrandomizedcontrolledtrials |