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Multiple sclerosis (MS) is an immune‐mediated disease of the central nervous system. Preliminary data show that mycophenolate mofetil (MMF), an immunosuppressive agent, might be beneficial for MS patients. The authors of this review evaluated the efficacy and safety of MMF in patients with relapsing‐remitting MS. Only one small study met the inclusion criteria, and it compared MMF versus placebo in 26 interferon β‐1a–treated patients. The results showed no evidence favoring MMF in reducing relapses or preventing disability progression after a 12‐month follow‐up period. No data were available at 24 months. All patients receiving MMF suffered from gastrointestinal upset, and one had a transient diarrhea, but no serious adverse effects were reported.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Allogeneic hematopoietic stem cell transplantation is a procedure in which a portion of a healthy donor's stem cells (cells that can develop into various types of blood cells) or bone marrow is obtained and prepared for intravenous infusion. Hematopoietic stem cells are taken from a healthy donor and transplanted into the patient (recipient). People undergoing allogeneic hematopoietic stem cell transplantation are at risk of developing graft‐versus‐host disease (GVHD). GVHD results when the transplanted cells from the donor (graft) attack the recipient's (host) body cells because they perceive the recipient's body as foreign. Mycophenolate mofetil and methotrexate are two drugs often used to suppress the human body's reaction against the graft (immune response) and prevent GVHD. We conducted a systematic review of three randomized controlled trials (RCTs, which are clinical studies where people are randomly put into one of two or more treatment groups) that compared mycophenolate mofetil versus methotrexate for use in preventing GVHD among 174 participants. We searched for the relevant studies in March 2014.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Lupus nephritis is an inflammatory condition affecting the kidneys which is caused by systemic lupus erythematosus (SLE), an autoimmune disease that is more common among women. About half of all people with SLE develop lupus nephritis, and of these about 1/10 experience chronic kidney disease or kidney failure. Treatment aims to delay disease progression and achieve remission by stabilising and improving kidney function and minimising side effects. For about the past 30 years, standard treatment for lupus nephritis has focused on a combination of cyclophosphamide (an alkylating agent) and corticosteroids.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

This review also showed that in patients with typical or diarrhoea associated haemolytic uraemic syndrome, there are no interventions that are superior to supportive therapy which includes control of fluid and electrolyte imbalance, use of dialysis if required, control of hypertension and blood transfusion as required.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

We reviewed the evidence for the benefits and harms of treatments that suppress or modify the immune system in multifocal motor neuropathy (MMN).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Almost every liver transplant recipient is treated with either the drug tacrolimus or the drug cyclosporine to prevent rejection of the transplanted liver. These drugs are part of a group of drugs called calcineurin inhibitors. Both tacrolimus and cyclosporine have serious and common adverse effects and, therefore, dose reduction or discontinuation of these drugs is frequently applied in clinical practice. The aim of the review was to compare reduction or withdrawal of tacrolimus or cyclosporine without substitution with another immunosuppressive agent with continuation of tacrolimus or cyclosporine. Through systematic searches of medical databases we found one ongoing randomised clinical trial investigating total withdrawal of immunosuppressive drugs but, at the time of conducting this review, no trial results on the outcome measures of interest to this review were published. Thus, we cannot reach any conclusion on beneficial or harmful effects of calcineurin inhibitor minimisation for liver transplant recipient patients.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Myasthenia gravis (MG) is caused by antibodies produced by the immune system that impair the transmission of nerve impulses to muscles. This results in muscle weakness that characteristically fluctuates. About one person in every 10 000 ‐ 50 000 develops MG each year. The natural history of the disorder is typically a series of exacerbations and remissions. Severe attacks can be life‐threatening because of weakness of muscles involved in swallowing causing choking, and chest muscles causing difficulty with breathing. In MG, immunosuppressant drugs act mainly by reducing the production of antibodies.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Nephrotic syndrome is a condition where the kidneys leak protein from the blood into the urine. Corticosteroids are used in the first instance to achieve remission. Some children do not respond to this treatment (steroid‐resistant nephrotic syndrome) and other agents such as cyclophosphamide, calcineurin inhibitors (cyclosporin, tacrolimus) or angiotensin‐converting enzyme inhibitors may be used.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Kidney transplants can improve the quality and length of life for patients with end‐stage kidney disease (ESKD) compared with chronic dialysis. To prevent a kidney transplant from being rejected by the body, immune‐system suppressing drugs (most commonly a calcineurin inhibitors (CNI)) are used. CNI are associated with high blood pressure, high lipid levels, an increased risk of developing diabetes, and chronic scarring of the kidney transplant. Chronic kidney scarring is the main reason that kidney transplants lose function in people who do not die before their kidney transplant fails. Belatacept might be an alternative immune‐system suppressing drug which prevents rejection but which also causes fewer side‐effects than CNI.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

After kidney transplantation, patients receive a combination of immunosuppressive medications to prevent rejection of the transplanted kidney. These regimens usually contain a calcineurin‐inhibitor (tacrolimus or cyclosporin A), corticosteroids and an antiproliferative agent (mycophenolic acid (MPA), e.g. mycophenolate mofetil (MMF), or azathioprine (AZA)). MPA is considered to be of stronger immunosuppressive potency than AZA, but the benefits on survival of the graft and its safe use over a long period of time are insufficiently understood.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

The cornea is the transparent front part of the eye that if damaged, can be replaced by a corneal transplant (keratoplasty) using healthy cornea tissue from a donor. A penetrating keratoplastyinvolves replacing all the damaged cornea. It is necessary to prevent the transplanted material (graft) from being rejected. The current strategies for preventing graft rejection are topical and oral steroids. The use of cyclosporine A (CsA), tacrolimus, mycophenolate mofetil (MMF), sirolimus, and leflunomide is increasing. However, the benefits and adverse reactions of these immunosuppressants have not yet been systematically reviewed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Hepatitis C virus is mainly transmitted by contact to infected blood. Chronic hepatitis C infection affects around 3% of the world population and progresses slowly. Most patients present without symptoms, or with symptoms like fatigue or liver‐related morbidity. Frequently, the disease is discovered by coincidence because of abnormal laboratory results. Around 5% to 40% of all infected patients will develop severe liver damage which can cause severe liver‐related morbidities and eventually death. Current treatment consists of pegylated interferon‐alpha plus ribavirin and in some subgroups of patients these agents are combined with telaprevir or boceprevir, or other direct acting antivirals. In about 70% of patients with chronic hepatitis C, it is possible to eradicate the virus from the blood, but the clinical effects are not known. Aminoadamantanes (another group of antiviral drugs), mostly amantadine, have been tested in several clinical trials. The authors have previously systematically reviewed amantadine versus placebo or no intervention and found no significant effects of amantadine.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Renal vasculitis presents as rapidly progressive glomerulonephritis which is a form of kidney disease that causes damage to the small structures (glomeruli) inside the kidneys that help filter waste and fluids from blood to form urine. The disease leads to a rapid loss of kidney function. Standard suppression of the immune system with steroids and cyclophosphamide is recommended. The aim of this review was to evaluate the benefits and harms of any intervention for the treatment of renal vasculitis. Thirty one studies (2217 patients) were identified. Plasma exchange reduces the risk of end‐stage kidney disease in patients presenting with severe acute kidney failure. The use of pulse cyclophosphamide results in good remission rates but there was an increased risk of relapse. Azathioprine is effective as maintenance therapy once remission has been achieved. Mycophenolate mofetil is equivalent for remission induction than cyclophosphamide. Mycophenolate mofetil has also been tested in maintenance treatment and was found to result in a higher rate of disease relapse. Initial data on rituximab showed equivalent effectiveness to cyclophosphamide. Methotrexate and leflunomide are useful in maintenance therapy but their relative effectiveness are not clearly defined. Treatment with co‐trimoxazole may prevent respiratory infections and relapses but are unlikely to have a major impact on systemic relapses of vasculitis.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Bullous pemphigoid (BP) is the most common autoimmune blistering disease in the West. Incidence figures are not available for most parts of the world but BP appears to be rarer in the Far East. Bullous pemphigoid is usually a disease of the elderly but it can also affect younger people and children. Both sexes are similarly affected. While BP usually resolves within five years, there is a moderate death rate associated with the disease and its treatment. Oral corticosteroid drugs are the most common treatment, but may be associated with serious adverse effects, including some deaths. The most common adverse effects of oral steroids, include weight gain and high blood pressure. Long‐term use is associated with an increased risk of diabetes mellitus and decreased bone density. Topical steroids are also associated with adverse effects, such as thinning of the skin and easy bruising. The risk of experiencing adverse effects of topical steroids depends on the strength of the steroid, how long it is used for, which area of the body it is applied to, and the kind of skin problem; if a high‐strength, potent steroid is used, enough may be absorbed through the skin to cause adverse effects in the rest of the body.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

This review of clinical trials aimed to find out which is the most effective and safest treatment option for pemphigus vulgaris and pemphigus foliaceus.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Children with nephrotic syndrome lose excessive amounts of protein from their bloodstream into their urine, causing swelling, especially in the face, stomach and legs. The risk of infection also increases because important proteins used by children's immune systems have been lost. Corticosteroid drugs, such as prednisone, can stop protein loss, but often happens again (relapse). Giving children further corticosteroids can lead to poor growth, cataracts, osteoporosis and high blood pressure.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Henoch‐Schönlein Purpura (HSP) causes inflammation of small blood vessels in children and affects approximately 20/100,000 children annually. Symptoms and signs include a purpuric skin rash (which comprises small spots and larger bruises), abdominal pain, gastrointestinal bleeding, joint pain and swelling, facial swelling and evidence of kidney disease with blood and protein in the urine. Kidney disease occurs in about one third of children with HSP. In the majority this is mild (small amounts of blood in the urine only) and resolves completely but a few children have persistent kidney disease that can progress to kidney failure.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Mucous membrane pemphigoid and epidermolysis bullosa acquisita are rare autoimmune blistering diseases of the skin and mucous membranes (eyes and mouth). They can result in scarring, which may lead to disabling and life threatening complications. Treatments include corticosteroids, mycophenolate mofetil and cyclophosphamide to suppress the immune system, and less toxic drugs such as antibiotics. These diseases often progress despite treatment. There is some evidence that mucous membrane pemphigoid involving the eyes may respond better to treatment with cyclophosphamide combined with corticosteroids, compared to treatment with corticosteroids alone. Cyclophosphamide is, however, associated with potentially severe adverse effects. Dapsone may help moderate disease. More research is needed to identify the most effective treatment options.There is not enough reliable evidence about treatments for the rare blistering diseases, mucous membrane pemphigoid and epidermolysis bullosa acquisita.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Kidney transplantation is the treatment of choice for most patients with end‐stage kidney disease. Strategies to increase donor organ availability and to prolong the transplanted kidney's survival have become priorities in kidney transplantation. About 10% to 35% of all kidney transplant recipients will experience one episode of acute rejection in the first year. Options for treating these episodes include pulsed steroid therapy, the use of an antibody preparation, the alteration of background immunosuppression, or combinations of these options.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2017

Idiopathic membranous nephropathy (IMN) is a disease in which glomerular basement membrane becomes thickening by light microscopy on renal biopsy and it represents a major cause of primary nephrotic syndrome in adults. A combined alkylating agent and corticosteroid regimen had short‐ and long‐term benefits on adult IMN with nephrotic syndrome. Among alkylating agents, cyclophosphamide was safer than chlorambucil. It should be emphasised that the number of included randomised studies with high‐quality design was relatively small and most of the included studies did not have adequate follow‐up and enough power to assess the prespecified outcomes. Meanwhile, this regimen was significantly associated with more withdrawals or hospitalisations. Although a six‐month course of alternating monthly cycles of corticosteroids and cyclophosphamide was recommended by the KDIGO Clinical Practice Guideline 2012 as the initial therapy for adult IMN with nephrotic syndrome, clinicians should inform their patients of the lack of high‐quality evidence for these benefits as well as the well‐recognised adverse effects of this therapy. Whether this combined therapy should be indicated in all adult patients at high risk of progression to ESKD or only restricted to those with deteriorating kidney function still remained unclear.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

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