Efficacy and safety of mycophenolate mofetil for IgA nephropathy: An updated meta‑analysis of randomized controlled trials

Zheng, Jiahe; Bi, Tong-dan; Zhu, Linbo; Liu, Linlin

doi:10.3892/etm.2018.6418

Cited by 8 publications

(6 citation statements)

References 31 publications

(40 reference statements)

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“…Not long ago, scholars reported that corticosteroids + MMF is an effective treatment in IgAN patients with a sustained decline in kidney function accompanied by persistent proteinuria and haematuria despite optimized conservative treatment ( Huerta et al, 2022 ). However, foreign prospective studies have not found that MMF has a renoprotective effect on IgAN ( Zheng et al, 2018 ). The inconsistency in research results in China and abroad suggests that genetic heterogeneity of different races has an impact on the pathogenesis of IgA.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of sequential immunosuppressive treatment for severe IgA nephropathy: A retrospective study

Luo

et al. 2023

Front. Pharmacol.

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Background: This study compared the efficacy and safety of sequential immunosuppressive therapy in patients with non-end-stage IgA nephropathy (IgAN) with Lee’s classification of IV ∼ V and provided evidence for the use of immunotherapy in patients with severe IgAN.Methods: We retrospectively analyzed the clinical data of patients with Lee’s IV ∼ V non-end-stage IgA nephropathy.Results: 436 patients were diagnosed with IgAN, and 98 patients who met the inclusion criteria were included in this retrospective study. Of these, 17 were in the supportive care group, 20 in the P group (prednisone-only), 35 in P + CTX group (the prednisone combined with cyclophosphamide followed by mycophenolate mofetil), and 26 in the P + MMF group (prednisone combined with mycophenolate mofetil). The four groups showed differences in the segmental glomerulosclerosis score and the proportion of patients with Lee’s grade IV (p < 0.05), but no differences in other indicators. Compared with the baseline values, urine protein-to-creatinine ratio (PCR) significantly decreased and serum albumin increased (p < 0.05), but there was no significant difference between the groups. The estimated Glomerular Filtration Rate (eGFR) of the P, P + MMF, and P + CTX groups were higher than that of the supportive care group at the 6th and 24th month after treatment (all p < 0.05). At the 24th month, the eGFR in the P + CTX group was higher than that in the P + MMF group (p < 0.05). The effective remission rate of the P + CTX group was higher than that of the supportive care group (p < 0.05). At 12 months, the effective remission rate of the P group was higher than that of the supportive care group (p < 0.05). At the 24th month, there was no significant difference in the effective remission rates among the three groups (P, P + MMF, and P + CTX). Nine patients with severe IgA nephropathy reached the endpoint.Conclusion: This study showed that immunosuppressive therapy insevere IgAN patient scan effectively reduce urinary protein, increase albumin, and protect renal function in the early stages of IgAN. P + CTX is the most commonly used, which has a high effective remission rate of urine protein and a low incidence of end-point events.

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Section: Discussionmentioning

confidence: 99%

Efficacy and safety of sequential immunosuppressive treatment for severe IgA nephropathy: A retrospective study

Luo

et al. 2023

Front. Pharmacol.

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“…Turning our attention to mycophenolic acid (MPA) derivatives, most of the evidence of its efficacy in IgAN is limited to native kidneys rather than recurrent disease. A metaanalysis looking at eight randomized clinical trials involving 510 patients found no overall differences in rates of disease remission or development of ESKD among regimens that did or did not include mycophenolate mofetil (MMF) [70]. On a sub-analysis, MMF improved renal remission (complete or partial) compared to placebo (three trials, relative risk 2.15; p = 0.010) but compared to those on an immunosuppressive regimen without MMF there were no differences (four trials, relative risk 1.14, p = 0.146).…”

Section: Treatmentmentioning

confidence: 99%

Recurrent Immunoglobulin A Nephropathy after Kidney Transplant—An Updated Review

Han,

Lubetzky,

Anandasivam

et al. 2023

Transplantology

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Immunoglobulin A nephropathy (IgAN) is the commonest glomerulonephritis worldwide, a category that represents the third most frequent cause of end-stage kidney disease (ESKD) in the United States. Kidney transplantation remains the optimal treatment of ESKD, and yet the prospects of IgAN recurrence post-transplant dampens the enthusiasm for living kidney donation in some instances, in addition to limiting the longevity of the kidney allograft. Moreover, the lack of a standardized method for detecting IgAN recurrence, since not all centers perform protocol allograft biopsies, has led to an underestimation of the extent of the issue. The pathogenesis of de novo IgAN remains conjectural, let alone the pathways for recurrent disease, but is increasingly recognized as a multi-hit injury mechanism. Identification of recurrent disease rests mainly on clinical symptoms and signs (e.g., hematuria, proteinuria) and could only be definitively proven with histologic evidence which is invasive and prone to sampling error. Treatment had relied mainly on nonspecific goals of proteinuria reduction, and in some cases, immunosuppression for active, crescentic disease. More recently, newer targets have the potential to widen the armamentarium for directed therapies, with more studies on the horizon. This review article provides an update on recurrent IgAN post-transplant.

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“…Small trials with Mycophenolate mofetil and hydroxychloroquine revealed mixed results in Asian groups [ 136 , 137 ]. A meta-analysis of RCTs for treatment with the mycophenolate mofetil in IgA showed no additional benefit or adverse events than other immunosuppressants [ 138 ]. Even rituximab, a monoclonal antibody against CD20+ B cells, does not improve proteinuria and renal function [ 139 ].…”

Section: Iga Nephropathymentioning

confidence: 99%

New Insights into the Treatment of Glomerular Diseases: When Mechanisms Become Vivid

Lin

Chang

Hsu

et al. 2022

IJMS

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Treatment for glomerular diseases has been extrapolated from the experience of other autoimmune disorders while the underlying pathogenic mechanisms were still not well understood. As the classification of glomerular diseases was based on patterns of juries instead of mechanisms, treatments were typically the art of try and error. With the advancement of molecular biology, the role of the immune agent in glomerular diseases is becoming more evident. The four-hit theory based on the discovery of gd-IgA1 gives a more transparent outline of the pathogenesis of IgA nephropathy (IgAN), and dysregulation of Treg plays a crucial role in the pathogenesis of minimal change disease (MCD). An epoch-making breakthrough is the discovery of PLA2R antibodies in the primary membranous nephropathy (pMN). This is the first biomarker applied for precision medicine in kidney disease. Understanding the immune system’s role in glomerular diseases allows the use of various immunosuppressants or other novel treatments, such as complement inhibitors, to treat glomerular diseases more reasonable. In this era of advocating personalized medicine, it is inevitable to develop precision medicine with mechanism-based novel biomarkers and novel therapies in kidney disease.

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Efficacy and safety of mycophenolate mofetil for IgA nephropathy: An updated meta‑analysis of randomized controlled trials

Cited by 8 publications

References 31 publications

Efficacy and safety of sequential immunosuppressive treatment for severe IgA nephropathy: A retrospective study

Efficacy and safety of sequential immunosuppressive treatment for severe IgA nephropathy: A retrospective study

Recurrent Immunoglobulin A Nephropathy after Kidney Transplant—An Updated Review

New Insights into the Treatment of Glomerular Diseases: When Mechanisms Become Vivid

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