Efficacy and safety of mycophenolate mofetil in patients with IgA nephropathy: an update meta-analysis

Abstract

BackgroundThe application of mycophenolate mofetil (MMF) in treating patients with immunoglobulin A nephropathy (IgAN) remains uncertain. This update meta-analysis was performed to re-evaluate the therapeutic potential of MMF in IgAN.MethodsArticles were obtained by searching the electronic databases without language restriction. Randomized controlled trials studying the role of MMF in treating IgAN were collected. The quality of included studies was critically evaluated. Data analyses were performed by using RevMan 5.3 software.ResultsA total of 297 articles were screened and eight articles were finally included. Among the eight randomized controlled trials, five and three were high quality and low quality, respectively. Both fixed-effect and random-effect model were used. Pooled results by combining all the eight studies suggested that IgAN patients in MMF group had a higher remission rate than that in control group. Compared to placebo or corticosteroid monotherapy, MMF monotherapy exerted a higher remission rate and side effect rate in both main analysis and subgroup analysis by human race. Compared to corticosteroid plus other immunosuppressive agent therapy, corticosteroid plus MMF therapy had a higher remission rate, lower serum creatinine doubling rate, progression to end-stage renal disease rate and side effects rate. Subgroup analysis by therapeutic regimen further confirmed these results between corticosteroid plus MMF therapy and corticosteroid plus cyclophosphamide therapy. Funnel-plot displayed a symmetrical figure, indicating no publication bias existed.ConclusionsMMF has the potential in treatment of IgAN, especially for Asians. The evidence currently available shows that MMF monotherapy has a more efficacy but higher side effects when compared to placebo or corticosteroid monotherapy in treatment of Asians with IgAN. While MMF combined with corticosteroid regimen has a more efficacy and lower side effects when compared with corticosteroid plus cyclophosphamide regimen.

Initial serum creatinine concentration affects clinical outcomes in patients with IgA nephropathy treated with mycophenolate mofetil combined with low‑dose prednisone

“…First, the number of observed events is small and limits the statistical power of this explorative study to a certain extent. However, according to a recent meta-analysis, eight randomized controlled trials have assessed the use of MMF in patients with IgA nephropathy (11,12,(28)(29)(30)(31)33,49,50). Most of them were also small-sized and the study with the biggest size included 84 patients (33).…”

Is mycophenolate mofetil combined with low-dose prednisone a treatment option for advanced IgA nephropathy? A 10-year follow-up case and brief literature review

“…Despite MMF was first used to treat IgAN in 1997, 8 some meta-analysis shows the efficacy of MMF in IgAN. 9 To date, the four published randomized controlled trials from China and western countries have shown different clinical profile in patients with IgAN. 10 Clinically, renal histologic features should not be considered a criterion for excluding patients from active treatment.…”

Is immunoglobulin A nephropathy different in different ethnic populations?

“…In the most recent randomized, double‐blind, placebo‐controlled trial, 44 patients from North America with IgAN was stopped prematurely due to lack of observed benefit . Putting these results together in a meta‐analysis, it was therefore not surprising that MMF was demonstrated to be of benefit in Asians but not Caucasians . In a recent study, 176 Chinese IgAN patients with active proliferative lesions were randomized to MMF with low dose steroids versus steroids alone and MMF was shown to be an effective steroid‐sparing agent but did not increase the rate of proteinuria remission at 6‐ and 12‐months .…”

“…82 Putting these results together in a meta-analysis, it was therefore not surprising that MMF was demonstrated to be of benefit in Asians but not Caucasians. 83 In a recent study, 176 Chinese IgAN patients with active proliferative lesions were randomized to MMF with low dose steroids versus steroids alone and MMF was shown to be an effective steroid-sparing agent but did not increase the rate of proteinuria remission at 6-and 12-months. 84 All these studies are limited by small sample size and the study populations differ inherently, but these striking differences between different ethnic populations remain intriguing.…”