ACTH Treatment for Management of Nephrotic Syndrome: A Systematic Review and Reappraisal

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.

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Rituximab in The Management of Pediatric Steroid-Resistant Nephrotic Syndrome: A Systematic Review

The Journal of Pediatrics ◽

10.1016/j.jpeds.2018.01.008 ◽

2018 ◽

Vol 197 ◽

pp. 191-197.e1 ◽

Cited By ~ 5

Author(s):

Manel Jellouli ◽

Rim Charfi ◽

Bayen Maalej ◽

Abdelmajid Mahfoud ◽

Sameh Trabelsi ◽

...

Keyword(s):

Systematic Review ◽

Nephrotic Syndrome ◽

Steroid Resistant ◽

Steroid Resistant Nephrotic Syndrome

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Interventions for steroid-resistant nephrotic syndrome: a systematic review

Pediatric Nephrology ◽

10.1007/s00467-003-1207-0 ◽

2003 ◽

Vol 18 (9) ◽

pp. 906-912 ◽

Cited By ~ 33

Author(s):

Doaa Habashy ◽

Elisabeth M. Hodson ◽

Jonathan C. Craig

Keyword(s):

Systematic Review ◽

Nephrotic Syndrome ◽

Steroid Resistant ◽

Steroid Resistant Nephrotic Syndrome

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Psychotherapeutic benefits of compassion-focused therapy: an early systematic review

Psychological Medicine ◽

10.1017/s0033291714002141 ◽

2014 ◽

Vol 45 (5) ◽

pp. 927-945 ◽

Cited By ~ 158

Author(s):

J. Leaviss ◽

L. Uttley

Keyword(s):

Systematic Review ◽

Large Scale ◽

Research Evidence ◽

Mental Health Problems ◽

Current Evidence ◽

Psychotherapeutic Intervention ◽

Randomized Controlled ◽

Randomized Controlled Studies ◽

Compassion Focused Therapy ◽

Comprehensive Search

Background.Compassion-focused therapy (CFT) is a relatively novel form of psychotherapy that was developed for people who have mental health problems primarily linked to high shame and self-criticism. The aim of this early systematic review was to draw together the current research evidence of the effectiveness of CFT as a psychotherapeutic intervention, and to provide recommendations that may inform the development of further trials.Method.A comprehensive search of electronic databases was undertaken to systematically identify literature relating to the effectiveness of CFT as a psychotherapeutic intervention. Reference lists of key journals were hand searched and contact with experts in the field was made to identify unpublished data.Results.Fourteen studies were included in the review, including three randomized controlled studies. The findings from the included studies were, in the most part, favourable to CFT, and in particular seemed to be effective for people who were high in self-criticism.Conclusions.CFT shows promise as an intervention for mood disorders, particularly those high in self-criticism. However, more large-scale, high-quality trials are needed before it can be considered evidence-based practice. The review highlights issues from the current evidence that may be used to inform such trials.

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Yoga and Mindfulness as Therapeutic Interventions for Stroke Rehabilitation: A Systematic Review

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2013/357108 ◽

2013 ◽

Vol 2013 ◽

pp. 1-9 ◽

Cited By ~ 25

Author(s):

Asimina Lazaridou ◽

Phaethon Philbrook ◽

Aria A. Tzika

Keyword(s):

Systematic Review ◽

Stroke Rehabilitation ◽

Negative Impact ◽

Single Case ◽

Therapeutic Interventions ◽

Systematic Assessment ◽

Randomized Controlled Clinical Trials ◽

Mindfulness Practices ◽

Comprehensive Search ◽

Study Type

Aim. This paper reports a systematic review and critical appraisal of the evidence on the effectiveness of behavioral therapies such as yoga and mindfulness practices for stroke rehabilitation.Background. The experience of stroke can have a negative impact on both psychological and physical health and on quality of life. Yoga and relevant practices are promising therapies that have been used with patients with a variety of conditions. In order to draw conclusions on effectiveness for stroke patients, the evidence requires systematic assessment.Methods. A comprehensive search of major biomedical and complementary medicine databases was conducted. Relevant research was categorized by study type and appraised according to study design.Results. Five randomized controlled clinical trials and four single case studies were found. Additionally, one qualitative research study was identified. Studies reported positive results, including improvements in cognition, mood, and balance and reductions in stress. Modifications to different yoga practices make comparison between studies difficult, and a lack of controlled studies precludes any firm conclusions on efficacy.Conclusion. Yoga and mindfulness could be clinically valuable self-administered intervention options for stroke rehabilitation. Further research is needed to evaluate these specific practices and their suitability in stroke rehabilitation.

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