Treatment of membranous nephropathy with mizoribine: A control trial

Wang, Xichao; Song, Xinyuan; Liu, Ying; Zhang, Wenyu; An, Wenwen; Tu, Yangke

doi:10.1016/j.lfs.2016.04.012

Cited by 10 publications

(15 citation statements)

References 8 publications

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“…A total of 1829 citations were retrieved based on electronic searches, and 12 additional studies were retrieved after checking the references of relevant reviews and guidelines. Ultimately, 48 studies21–68 including 2736 adults were available for network meta-analysis. These trials evaluated 13 different immunosuppressive treatment regimens, including ACTH, AZA, chlorambucil (CH), cyclophosphamide (CTX), cyclosporine (CsA), leflunomide (LEF), MMF, MZB, rituximab (RIT), steroids (STE), tacrolimus (TAC), tacrolimus+tripterygiumwilfordii (TAC+TW) and TW for patients with IMN.…”

Section: Resultsmentioning

confidence: 99%

“…TR (complete or PR) was reported in 2581 of the 2736 patients from a total of 45 studies 19–34 36–48 50–65. There were 13 immunosuppressive agents, including ACTH (1 trial, 16 patients), AZA (2, 18), CH (9, 268), CTX (21, 665), CsA (8, 167), LEF (2, 25), MMF (7, 139), MZB (1, 30), RIT (1, 37), STE (6, 179), TAC (15, 412), TAC+TW (2, 35) and TW (2, 93).…”

Section: Resultsmentioning

confidence: 99%

“…For the 24 hours UTP, 30 RCTs21 23 24 26–29 31 32 34 37–39 42 43 45 47 48 51 52 56–60 63–67 with 1682 patients were included in the network meta-analysis. There were 11 immunosuppressive agents, including AZA (2 trials, 18 patients), CH (4, 112), CTX (16, 487), CsA (6, 78), LEF (2, 25), MMF (3, 85), MZB (1, 30), RIT (1, 37), STE (4, 122), TAC (10, 257) and TAC+TW (2, 35).…”

Section: Resultsmentioning

confidence: 99%

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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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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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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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“…The mean study baseline creatinine ranged from 0.74 to 2.7 mg/dL (median 1.18 mg/dL) and the mean study 24-h urine protein excretion ranged between 1.64 and 12.8 g/day (median 7.86 g/day). Follow-up for Cyclophosphamide was compared with steroid monotherapy (3 trials, 137 participants) [27,41,57], calcineurin inhibitor (4 trials, 299 participants) [34,44,64,72], rituximab (1 trial, 74 participants) [14], calcineurin inhibitor plus rituximab (1 trial, 86 participants) [12], chlorambucil (3 trials, 145 participants) [29,59,65], mycophenolate mofetil (1 trial, 22 participants) [68], mizoribine (1 trial, 55 participants) [71], ACTH (1 trial, 32 participants) [60], non-immunosuppressive therapy (4 trials, 209 participants) [38,47,54,70] and Chinese herbal medicine (1 trial, 190 participants) [35]. There were 3 trials with 59 participants, which compared different protocols of cyclophosphamide (early versus late initiation or intravenous versus oral) [37,45].…”

Section: Selection and Description Of Studiesmentioning

confidence: 99%

Immunosuppression therapy for idiopathic membranous nephropathy: systematic review with network meta-analysis

et al. 2022

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Background Idiopathic membranous nephropathy is a common cause of nephrotic syndrome in adults. The Kidney Disease Improving Global Outcomes guidelines recommend rituximab or cyclophosphamide and steroids, or calcineurin inhibitor-based therapy. However, there have been few or no head-to-head comparisons of the relative efficacy and safety of different immunosuppression regimens. We conducted a network meta-analysis to evaluate the comparative efficacy and safety of available immunosuppression strategies compared to cyclophosphamide in adults with idiopathic membranous nephropathy. Methods We performed a systematic search of MEDLINE, Embase and CENTRAL for randomized controlled trials in the treatment of adults with idiopathic membranous nephropathy. The primary outcome was complete remission. Secondary outcomes were kidney failure, partial remission, estimated glomerular filtration rate, doubling of serum creatinine, proteinuria, serious adverse events, discontinuation of treatment, serious infection and bone marrow suppression. Results Cyclophosphamide had uncertain effects on inducing complete remission when compared to rituximab (OR 0.35, CI 0.10–1.24, low certainty evidence), mycophenolate mofetil (OR 1.81, CI 0.69–4.71, low certainty), calcineurin inhibitor (OR 1.26, CI 0.61–2.63, low certainty) or steroid monotherapy (OR 2.31, CI 0.62–8.52, low certainty). Cyclophosphamide had a higher probability of inducing complete remission when compared to calcineurin inhibitor plus rituximab (OR 4.45, CI 1.04–19.10, low certainty). Compared to other immunosuppression strategies, there was limited evidence that cyclophosphamide had different effects on other pre-specified outcomes. Conclusions The comparative effectiveness and safety of immunosuppression strategies compared to cyclophosphamide is uncertain in adults with idiopathic membranous nephropathy. Graphical abstract

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“…Although the use of CY can achieve satisfactory therapeutic efficacy, its side effects, including bone marrow suppression, gonadal toxicity, and an increased risk of malignancy, have been a concern. Furthermore, there is a report that MZB is safer with non-inferior efficacy to CY ( 25 ), so we selected it for MN. Although this standard therapy alone failed to achieve CR of MN in the present case, interestingly, the additional administration of IVIG provided for steroid-resistant peripheral neuropathy caused by EGPA eventually led to CR of MN.…”

Section: Discussionmentioning

confidence: 99%

The First Case of Eosinophilic Granulomatosis with Polyangiitis Simultaneously Demonstrating Various Clinical Manifestations with Retroperitoneal Fibrosis and Membranous Nephropathy

et al. 2021

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The first case of eosinophilic granulomatosis with polyangiitis (EGPA) simultaneously demonstrating various clinical manifestations, including retroperitoneal fibrosis (RPF) causing hydronephrosis and membranous nephropathy (MN) leading to nephrotic syndrome, is presented. There have been no previous case reports demonstrating the simultaneous onset of these three disease categories with significant complex pathologies. This case was successfully managed by providing adequate combination therapies according to each disease category, leading to complete remission (CR) of all three diseases. In conclusion, we believe this case is extremely rare and clinically suggestive, and that these findings can be applied to a future phenotype-tailored treatment strategy for EGPA.

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Treatment of membranous nephropathy with mizoribine: A control trial

Cited by 10 publications

References 8 publications

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

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

Immunosuppression therapy for idiopathic membranous nephropathy: systematic review with network meta-analysis

The First Case of Eosinophilic Granulomatosis with Polyangiitis Simultaneously Demonstrating Various Clinical Manifestations with Retroperitoneal Fibrosis and Membranous Nephropathy

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