The efficacy and safety of immunosuppressive therapies in the treatment of IgA nephropathy: A network meta-analysis

Abstract

The protocol of this systematic review and network meta-analysis was submitted to the PROSPERO register and the registration number is CRD42019122324. The original data are available in the supplementary information. Because no human beings or animals were part of this study, ethics committee approval was not required. Search strategies. Two investigators (TJX and DLQ) independently performed a systematic literature retrieval. Commonly used databases, including Medline, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and EMBASE, were searched on December 30, 2018, and the last searched date was April 1, 2019. The text-word terms and subject headings we used in this study were "Immunoglobulin A nephropathy", "cyclophosphamide", "azathioprine", "tacrolimus", "mycophenolic acid", "mycophenolate mofetil", "steroids", and "glucocorticoid". The syntax used in each database is shown in Supplementary Table 1 (Table S1). To avoid omitting important articles, we also hand-searched the references of each retrieved study, relevant reviews, editorials and commentary.

Differential expression of peptides serves as an indicator of IgA nephropathy in pediatric patients

“…The results of the present study also indicated that the downregulated IgAN-specific peptide, PPPVLAK, may function as an ACEI. Consistently, ACEI agents have been revealed to be a promising therapy for IgAN due to their significant effects on reducing proteinuria (37). Therefore, based on the results of the present study, it is proposed that absence of the pro-angiogenic peptide combined with deficiency of ACEI peptide may be involved in the pathogenesis of IgAN in pediatric patients.…”

Clinical efficacy and safety of full-dose versus half-dose corticosteroids plus leflunomide for IgA nephropathy

“…The updated KDIGO guidelines suggested that all IgAN with proteinuria > 0.5 g/24 h, irrespective of whether they have hypertension, are treated with either an ACEi or ARB [ 3 ]. However, the current evidence about the different immunosuppression therapies remains to be elucidated [ 3 , 4 , 7 ]. Thus, we first conducted a retrospective cohort study with 149 IgAN patients to evaluate the effectiveness and safety of half-dose CS plus LEF vs. full-dose CS.…”

“…A variety of immunosuppressants have been used for clinical treatment of IgAN, including cyclophosphamide (CTX), leflunomide (LEF), CS, azathioprine, mycophenolate mofetil, tacrolimus [5][6][7], etc. However, the protective role of immunosuppressive therapy was still in controversy [3,8].…”

Long-term effects of immunosuppression treatment on IgA nephropathy: a systematic review and meta-analysis

“…Among the immunosuppressive therapies for IgA nephropathy, corticosteroids, cyclophosphamide, azathioprine, and mycophenolate mofetil (MMF) are the most common therapeutic agents (4). A meta-analysis (5) has systematically evaluated immunosuppressive therapy for IgA nephropathy and showed it has a significant effect on reducing renal injury caused by proliferative IgA nephropathy, but these meta-analyses focused on the short-term efficacy of immunosuppressive drugs and did not evaluate the long-term efficacy of these drugs. Another meta-analysis conducted by Natale et al (6) has reported the long-term efficacy of immunosuppressive agents but it included quasi-randomised studies and risk of bias was high, the quality of the evidence was low.…”