Abstract
Autosomal Dominant Polycystic Kidney Disease (ADPKD) is a hereditary disorder characterized by formation and progressive growth of cysts in the kidneys and other organs such as liver, spleen, and pancreas. Recent advances have led to possibilities to target the main cause of cyst growth, cAMP. Somatostatin targets cAMP and inhibits its production directly and indirectly in kidney and liver, which might potentially prevent renal and liver cyst progression in ADPKD. This report aims to evaluate the effectiveness of somatostatin analogue therapy in slowing disease progression in ADPKD patients, according to the latest evidence. A literature search was conducted on five databases, namely the Cochrane Library, EBSCO, Embase, ProQuest, and PubMed/MEDLINE. Selected articles are screened for duplication, title and abstract, as well as based on eligibility criteria. The selected articles were then critically appraised using the Oxford Center for Evidence Based Medicine (CEBM) critical appraisal tools for therapeutic study and systematic review as a guide. The systematic search resulted in one meta-analysis assessing the effectiveness of somatostatin analogues in ADPKD patients in terms of Total Kidney Volume (TKV), Total Liver Volume (TLV), and eGFR. This article analyzed 10 RCTs with a total sample size of 854 subjects. This study showed that somatostatin analogue is associated with lower TLV (%TLV) growth (MD -6.37%; 95% CI -7.90 to -4.84; p<0.001; I2 = 14%), and lower TKV (%TKV) growth rate (MD -3.66%; 95% CI -5.35 to -1.97; p<0.001; I2 = 56%). However, it was not associated with eGFR decline (MD -0.96 mL/min/1.73m2; 95% CI -2.38 to 0.46; p = 0.19; I2 = 74%). Adverse effects were mainly gastrointestinal tract symptoms, and approximately 15% of test subjects administered with somatostatin analogue permanently discontinued the drug. Somatostatin analogue therapy has benefit in slowing TLV and TKV growth which outweigh the cost and risk of therapy. In conclusion, somatostatin can be recommended as therapy in ADPKD patients presenting with both kidney and liver cyst.
Bahasa Abstract
Autosomal Dominant Polycystic Kidney Disease (ADPKD) adalah kelainan herediter yang ditandai dengan pembentukan dan pertumbuhan progresif kista di ginjal dan organ lain seperti hati, limpa, dan pankreas. Kemajuan terbaru memungkinkan terapi yang bekerja pada penyebab utama pertumbuhan kista, cAMP. Somatostatin memengaruhi cAMP dengan menghambat produksinya secara langsung dan tidak langsung di ginjal dan hati, yang berpotensi mencegah perkembangan kista ginjal dan hati pada ADPKD. Laporan ini bertujuan untuk mengevaluasi efektivitas terapi analog somatostatin dalam menghambat perkembangan penyakit pada pasien ADPKD, menurut bukti terbaru. Pencarian literatur dilakukan pada lima database, yaitu Cochrane Library, EBSCO, Embase, ProQuest, dan PubMed/MEDLINE. Artikel yang tersaring dilakukan skrining duplikasi, judul dan abstrak, serta kriteria kelayakan. Artikel terpilih kemudian ditelaah secara kritis menggunakan alat telaah kritis Oxford Center for Evidence Based Medicine (CEBM) untuk studi terapeutik dan tinjauan sistematis. Pencarian sistematis menghasilkan satu meta-analisis yang menilai efektivitas analog somatostatin pada pasien ADPKD dalam hal Total Kidney Volume (TKV), Total Liver Volume (TLV), dan eGFR. Artikel ini menganalisis 10 RCT dengan jumlah sampel total 854 subjek. Studi ini menunjukkan bahwa analog somatostatin dikaitkan dengan pertumbuhan TLV (%TLV) yang lebih rendah dengan mean difference (MD) -6,37% (IK 95% -7,90 hingga -4,84; p<0,001; I2 = 14%), dan pertumbuhan TKV (%TKV) yang lebih rendah dengan MD -3,66% (IK 95% -5,35 hingga -1,97; p<0,001; I2 = 56%). Namun, tidak ditemukan kaitan dengan penurunan eGFR (MD -0,96 mL/min/1,73m2; IK 95% -2,38 hingga 0,46; p = 0,19; I2 = 74%). Efek samping yang ditemukan terutama gejala saluran pencernaan, dan sekitar 15% subjek menghentikan obat secara permanen. Manfaat somatostatin dalam menghambat pertumbuhan TLV dan TKV lebih besar daripada biaya dan risiko terapi, dan terapi somatostatin direkomendasikan pada pasien ADPKD yang mengalami kista ginjal dan hati.
Kata Kunci: Autosomal Dominant Polycystic Kidney Disease, somatostatin, TKV, TLV
Recommended Citation
Sitompul, Irvin Rembrant Holleritz; Putri, Grasella Angelika; and Laksmi, Purwita Wijaya
(2024)
"Efek Terapeutik Analog Somatostatin dalam Menghambat Perkembangan Autosomal Dominant Polycystic Kidney Disease,"
Jurnal Penyakit Dalam Indonesia: Vol. 11:
Iss.
4, Article 8.
DOI: 10.7454/jpdi.v11i4.1452
Available at:
https://scholarhub.ui.ac.id/jpdi/vol11/iss4/8
