Efficacy and Safety of Tacrolimus Versus Cyclophosphamide for Primary Membranous Nephropathy: A Meta-Analysis

Zhu, Linbo; Liu, Linlin; Li, Yao; Wang, Lining

doi:10.1007/s40265-016-0683-z

Cited by 28 publications

(22 citation statements)

References 26 publications

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“…Zhu et al conducted a meta-analysis of four RCTs and two prospective cohort studies and found similar therapeutic effects between TAC and CTX for inducing renal remission within 1 year. Moreover, TAC was associated with an increased risk of tremor, and reduced risk of leukopenia [34]. A meta-analysis conducted by Lin et al [35] found TAC therapy was associated with high total remission and low proteinuria level as compared with CTX for patients with IMN.…”

Section: Discussionmentioning

confidence: 99%

Tacrolimus versus cyclophosphamide for patients with idiopathic membranous nephropathy and treated with steroids: a systematic review and meta-analysis of randomized controlled trials

et al. 2021

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Section: Discussionmentioning

confidence: 99%

Tacrolimus versus cyclophosphamide for patients with idiopathic membranous nephropathy and treated with steroids: a systematic review and meta-analysis of randomized controlled trials

et al. 2021

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“…Moreover, TAC is more favourable than CsA for patients with IMN 69. Another meta-analysis showed that tacrolimus was comparable with CTX for inducing renal remission of patients with primary MN within 1 year 71. Therefore, the short-term efficacy of TAC in the treatment of IMN is positive, but its long-term effect remains to be further studied.…”

Section: Discussionmentioning

confidence: 99%

Comparative efficacy of 13 immunosuppressive agents for idiopathic membranous nephropathy in adults with nephrotic syndrome: a systematic review and network meta-analysis

et al. 2019

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ObjectivesThis study aimed to compare the effectiveness of 13 types of immunosuppressive agents used to treat idiopathic membranous nephropathy (IMN) in adults with nephrotic syndrome.DesignSystematic review and network meta-analysis.Data sourcesPubMed, EMbase, Cochrane Library, Web of Science, Clinical trials, SinoMed, Chinese Biomedicine, CNKI, WanFang and Chongqing VIP Information databases were comprehensively searched until February 2018.Eligibility criteriaRandomised clinical trials (RCTs) comparing the effects of different immunosuppressive treatments in adult patients with IMN and nephrotic syndrome were included, and all included RCTs had a study-duration of at least 6 months.Data extraction and synthesisTwo reviewers independently screened articles, extracted data and assessed study quality. Standard pairwise meta-analysis was performed using DerSimonian-Laird random-effects model.ResultsThis study ultimately included 48 RCTs with 2736 patients and 13 immunosuppressive agents. The network meta-analysis results showed that most regimens, except for leflunomide (LEF), mizoribine (MZB) and steroids (STE), showed significantly higher probabilities of total remission (TR) when compared with non-immunosuppressive therapies (the control group),with risk ratios (RRs) of 2.71 (95% CI) 1.81 to 4.06)for tacrolimus+tripterygium wilfordii (TAC+TW), 2.16 (1.27 to 3.69) foradrenocorticotropic hormone, 2.02 (1.64 to 2.49) for TAC, 2.03 (1.13 to3.64) for azathioprine (AZA), 1.91 (1.46 to 2.50) for cyclosporine (CsA), 1.86 (1.44 to2.42) for mycophenolate mofetil (MMF), 1.85 (1.52 to 2.25) for cyclophosphamide (CTX),1.81 (1.10 to 2.98) for rituximab (RIT), 1.80 (1.38 to 2.33) for TW, 1.72 (1.35 to 2.19) for chlorambucil. As for 24 hours UTP, the direct andindirect comparisons showed that AZA (standard mean difference (SMD), −1.02(95% CI −1.90 to −0.15)), CsA (SMD, −0.70 (95% CI −1.33 to −0.08)),CTX (SMD, −1.01 (95% CI −1.44 to -0.58)), MMF (SMD, −0.98 (95% CI −1.64 to −0.32)), MZB (SMD, −0.97 (95% CI −1.90 to−0.04]), TAC (SMD, −1.16 (95% CI −1.72 to −0.60)) and TAC+TW(SMD, −2.03 (95% CI −2.94 to −1.12)) could significantly superior thancontrol, except for chlorambucil, LEF, RIT and STE. Thechanges of serum creatinine (Scr) was not significantly different between eachtreatments of immunosuppressive agents and the control, except for STE whichhas the possibility of increasing Scr (SMD, 1.00 (95% CI 0.36 to 1.64)).Comparisons among all treatments of immunosuppressive agents showed nostatistical significance in the outcome of relapse. A drenocorticotropichormone (85.1%) showed the lowest probability of relapse under the cumulativeranking curve values among all immunosuppressants. Infection,gastrointestinal symptoms, and bone marrow suppression were the common adverseevents associated with most of the immunosuppressive therapies.ConclusionsThis study demonstrates that TAC+TW, TAC and CTX are superior to other immunosuppressive agents in terms of TR and 24 hours UTP. Moreover, they are all at risk of infection, gastrointestinal symptoms, and myelosuppression. Furthermore, TAC could increase the risk of glucose intolerance or new-onset diabetes mellitus. Conversely, STE alone, LEF and MZB seem to have little advantage in clinical treatment of IMN.PROSPERO registration numberCRD42018094228.

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“…Recently, when treating patients with significant kidney damage or a conservative treatment history, the Italian Ponticelli recommends treatment of IMN, suggesting the combination of the methylprednisolone with the oral cyclophosphamide (CTX) 9. However, CTX leads to severe side effects in many patients, such as gonadoinhibition, marrow toxicity, hemorrhagic cystitis, hepatotoxicity, and cancer 10,11…”

Section: Introductionmentioning

confidence: 99%

<p>Efficacy and safety of cyclosporine A in the treatment of idiopathic membranous nephropathy in an Asian population</p>

Lin¹,

Li²,

Zhou³

et al. 2019

DDDT

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Introduction The efficacy of cyclosporine A (CsA) in the treatment of idiopathic membranous nephropathy (IMN) is unclear. This meta-analysis was conducted to assess the efficacy and the safety of CsA in the treatment of IMN in Asians. Methods We searched the Pubmed, China Biomedical Database, CNKI, Wanfang Data, VIP, and EMBASE (November 30, 2018) systematically to identify the appropriate randomized controlled trials (RCTs) reporting the efficacy and the safety of CsA and glucocorticoid (GC) treatment vs other immunosuppressants and GC on patients with IMN in Asian populations. Results The CsA treated group entered complete remission (CR) faster (3 months) than a cyclophosphamide (CTX) group. While the CsA group lower inefficacy rates and higher total remission (TR, CR, or partial remission) than the CTX group in the total treatment (3 months, 6 months, and 12 months), it had a higher relapse rate. As for the CsA group vs the tacrolimus (TAC) group, the TAC had a significant effect in increasing the CR and the TR, with decreased no remission. With the therapeutic regimens of CsA+GC vs CTX+GC, the CsA exhibited better efficacy in lowering the proteinuria levels only at 12 months, not at 3 months or 6 months. Severe events like leucopenia, hemorrhagic cystitis, and alopecia were observed in the CTX group. Gingival hyperplasia, hirsutism, and elevated blood pressure were reported only in the CsA group. Gastrointestinal syndrome, liver function lesion, happened more frequently in the CTX group, and elevated uric acid was more common in the CsA group. Conclusions In brief, the CsA has better efficacy than the CTX group in the Asian population, with mild adverse effects but higher relapse rates in short-term treatment.

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Efficacy and Safety of Tacrolimus Versus Cyclophosphamide for Primary Membranous Nephropathy: A Meta-Analysis

Cited by 28 publications

References 26 publications

Tacrolimus versus cyclophosphamide for patients with idiopathic membranous nephropathy and treated with steroids: a systematic review and meta-analysis of randomized controlled trials

Tacrolimus versus cyclophosphamide for patients with idiopathic membranous nephropathy and treated with steroids: a systematic review and meta-analysis of randomized controlled trials

Comparative efficacy of 13 immunosuppressive agents for idiopathic membranous nephropathy in adults with nephrotic syndrome: a systematic review and network meta-analysis

<p>Efficacy and safety of cyclosporine A in the treatment of idiopathic membranous nephropathy in an Asian population</p>

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