Immunosuppressive Treatment for Nephrotic Idiopathic Membranous Nephropathy: A Meta-Analysis Based on Chinese Adults

Abstract

BackgroundIdiopathic membranous nephropathy (IMN) is the most common pathological type for nephrotic syndrome in adults in western countries and China. The benefits and harms of immunosuppressive treatment in IMN remain controversial.ObjectivesTo assess the efficacy and safety of different immunosuppressive agents in the treatment of nephrotic syndrome caused by IMN.MethodsPubMed, EMBASE, Cochrane Library and wanfang, weipu, qinghuatongfang, were searched for relevant studies published before December 2011. Reference lists of nephrology textbooks, review articles were checked. A meta-analysis of randomized controlled trials (RCTs) meeting the criteria was performed using Review Manager.Main Results17 studies were included, involving 696 patients. Calcineurin inhibitors had a better effect when compared to alkylating agents, on complete remission (RR 1.61, 95% CI 1.13, to 2.30 P = 0.008), partial or complete remission (effective) (CR/PR, RR 1.29, 95% CI 1.09 to 1.52 P = 0.003), and fewer side effects. Among calcineurin inhibitors, tacrolimus (TAC) was shown statistical significance in inducing more remissions. When compared to cyclophosphamide (CTX), leflunomide (LET) showed no beneficial effect, mycophenolate mofetil (MMF) showed significant beneficial on effectiveness (CR/PR, RR: 1.41, 95% CI 1.16 to 1.72 P = 0.0006) but not significant on complete remission (CR, RR: 1.38, 95% CI 0.89 to 2.13 P = 0.15).ConclusionsThis analysis based on Chinese adults and short duration RCTs suggested calcineurin inhibitors, especially TAC, were more effective in proteinuria reduction in IMN with acceptable side effects. Long duration RCTs were needed to confirm the long-term effects of those agents in nephrotic IMN.

Detection and clinical significance of glomerular M‐type phospholipase A2 receptor in patients with idiopathic membranous nephropathy

“…The combination of immunosuppressive agents and glucocorticoid can effectively reduce proteinuria in IMN patients and improve clinical outcomes; however, not all patients respond to the treatment . We found that PLA 2 R staining results may predict the response to immunosuppressive therapy in IMN patients.…”

Endoplasmic Reticulum Stress Predicts Clinical Response to Cyclosporine Treatment in Primary Membranous Nephropathy

“…In a meta-analysis, Xie et al [19] included 17 randomized controlled trials encompassing 696 Chinese PMN patients, who had been treated with different immunosuppressive agents, where 7 trials involving 282 patients in comparison CNIs with alkylating agents, found that CNIs led to a higher effect on CR and PR rate with fewer side effects in the Chinese population. While studies have demonstrated efficacy of CNIs, safety concerns include multiple side effects, including the risk of nephrotoxicity with long-term exposure [20].…”

Comparison of Second-Line Immunosuppressants for Childhood Refractory Nephrotic Syndrome: A Systematic Review and Network Meta-Analysis

“…Several meta-analyses have assessed the efficacy and safety of immunosuppression in nephrotic syndrome 5 7 32 33. Durkan et al 5 (2001) included 17 RCTs with a total of 631 children.…”

“…Two meta-analyses evaluated immunosuppressive therapy in adults with nephrotic idiopathic membranous nephropathy 32 33. Chen et al 32 included 36 RCTs with 1762 patients.…”