Treatment of severe IgA nephropathy: mycophenolate mofetil/prednisone compared to cyclophosphamide/prednisone

Liu, Xiaowei; De-wei, DU; Sun, Shiren; Xu, Guoshuang; Liu, Hongbao; He, Lijie; Zhang, Peng

doi:10.5414/cp201887

Cited by 22 publications

(28 citation statements)

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“…Of the eight studies, there were five and three studies using corticosteroid-free, MMF monotherapy [12, 13, 15, 16, 19] and corticosteroid plus MMF therapy [17, 18, 25], respectively. Moreover, there were five, two and one RCTs investigating Asians [12, 13, 17, 18, 25], Caucasians [15, 16] and mixed races [19], respectively. The flow chart for the selection of RCTs to be included in our analysis was shown in Fig.…”

Section: Resultsmentioning

confidence: 99%

Efficacy and safety of mycophenolate mofetil in patients with IgA nephropathy: an update meta-analysis

Jia

Zhou

et al. 2017

BMC Nephrol

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BackgroundThe application of mycophenolate mofetil (MMF) in treating patients with immunoglobulin A nephropathy (IgAN) remains uncertain. This update meta-analysis was performed to re-evaluate the therapeutic potential of MMF in IgAN.MethodsArticles were obtained by searching the electronic databases without language restriction. Randomized controlled trials studying the role of MMF in treating IgAN were collected. The quality of included studies was critically evaluated. Data analyses were performed by using RevMan 5.3 software.ResultsA total of 297 articles were screened and eight articles were finally included. Among the eight randomized controlled trials, five and three were high quality and low quality, respectively. Both fixed-effect and random-effect model were used. Pooled results by combining all the eight studies suggested that IgAN patients in MMF group had a higher remission rate than that in control group. Compared to placebo or corticosteroid monotherapy, MMF monotherapy exerted a higher remission rate and side effect rate in both main analysis and subgroup analysis by human race. Compared to corticosteroid plus other immunosuppressive agent therapy, corticosteroid plus MMF therapy had a higher remission rate, lower serum creatinine doubling rate, progression to end-stage renal disease rate and side effects rate. Subgroup analysis by therapeutic regimen further confirmed these results between corticosteroid plus MMF therapy and corticosteroid plus cyclophosphamide therapy. Funnel-plot displayed a symmetrical figure, indicating no publication bias existed.ConclusionsMMF has the potential in treatment of IgAN, especially for Asians. The evidence currently available shows that MMF monotherapy has a more efficacy but higher side effects when compared to placebo or corticosteroid monotherapy in treatment of Asians with IgAN. While MMF combined with corticosteroid regimen has a more efficacy and lower side effects when compared with corticosteroid plus cyclophosphamide regimen.

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Section: Resultsmentioning

confidence: 99%

Efficacy and safety of mycophenolate mofetil in patients with IgA nephropathy: an update meta-analysis

Jia

Zhou

et al. 2017

BMC Nephrol

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“…The present meta-analysis of all RCTs, which analyzed the efficacy and safety of MMF in IgAN, including recently published trials (9–11), may supply comprehensive evidence on the use of MMF in IgAN. MMF was superior to placebo for renal remission, but not for ESRD.…”

Section: Discussionmentioning

confidence: 99%

“…Various studies have determined that there were no differences between therapeutic regimens that did and did not utilize MMF in patients with IgAN (10,12,15,16). However, other studies have demonstrated that the therapeutic regimens with MMF were superior to those without (11,13,14,17). The previously published meta-analyses also demonstrated different results; some demonstrated the superiority of MMF for IgAN (19,21), but others failed to exhibit any difference (18,20).…”

Section: Introductionmentioning

confidence: 95%

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

Zheng

Zhu

et al. 2018

Exp Ther Med

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The efficacy and safety of mycophenolate mofetil (MMF) for immunoglobulin A nephropathy (IgAN) remains debatable. Therefore, the present meta-analysis was conducted with randomized controlled trials (RCTs). PubMed/MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials were analyzed to identify eligible trials. The pooled risk ratio (RR) with 95% confidence interval (CI) was estimated for all the dichotomous outcome measures. A total of eight RCTs with nine publications (n=510 patients) were included. No significant difference was noted between therapeutic regimens with and without MMF for renal remission and end stage renal disease (ESRD) of patients with IgAN (seven trials; RR, 1.250; 95% CI, 0.993–1.574; P=0.057; and four trials; RR, 0.728; 95% CI, 0.164–3.236; P=0.676). To further define the effects of MMF for renal remission, subgroup analysis was performed, demonstrating that MMF was significantly more effective compared with the placebo (three trials; RR, 2.152; 95% CI, 1.198–3.867; P=0.010), although the immunosuppressive regimens with MMF had no significantly different effects compared with those without MMF (four trials; RR, 1.140; 95% CI, 0.955–1.361; P=0.146), indicating that MMF was superior to placebo and had a similar efficacy to other immunosuppressants for renal remission. In addition, subgroup analysis for ESRD revealed no significant differences between MMF and placebo and between the immunosuppressive regimens with and without MMF (three trials; RR, 0.957; 95% CI, 0.160–5.726; P=0.962; and one trial; RR, 0.205; 95% CI, 0.010–4.200; P=0.303). Furthermore, there were no significant differences between the therapeutic regimens with and without MMF in terms of the risk of adverse events. The present meta-analysis demonstrated that MMF was more effective compared with the placebo, may have similar efficacy to other immunosuppressants in terms of inducing renal remission of IgAN and may not increase the risk of adverse events. The long-term effects of MMF on the prognosis of patients with IgAN require verification in further studies.

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“…In another Italian study, a subset of IgAN patients with florid glomerular changes treated with MMF and steroid showed remission of proteinuria and reversal of progressive renal failure [47]. A recent study from China compared between combined therapy with MMF and prednisone and combined therapy of cyclophosphamide and prednisone for severe IgAN [48]. The former achieved a higher remission rate with better reduction of proteinuria and improvement of renal function.…”

Section: Immunomodulatory Treatmentmentioning

confidence: 99%

The Treatment of IgA Nephropathy

2015

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Background: IgA nephropathy (IgAN) is a very common glomerulonephritis worldwide. Nevertheless, treatment options for primary IgAN are still largely based on opinion or weak evidence. There is a lack of large randomized controlled trials (RCT) that provide a definitive immunosuppressive protocol for IgAN. The recent KDIGO Clinical Practice Guidelines for Glomerulonephritis have assigned low levels of evidence for almost all recommendations and suggestions related to this nephropathy. Summary: In this article, we review different treatment options and emphasize that the key to therapeutic decision-making is the assessment of an individual's prognosis. The risk of disease progression is closely related to clinical parameters such as proteinuria, hypertension, and impaired glomerular filtration rate. For patients with minor urinary abnormalities, the mainstay of treatment is long-term regular follow-up to detect renal progression and hypertension. Optimized supportive care aiming to maintain proteinuria <1 g/day is preferred in the typical patient presenting with microhematuria, significant but nonnephrotic proteinuria, hypertension, and variable degrees of renal failure. The atypical patient with overt nephritic syndrome or rapidly progressive kidney injury that represents a vasculitic form of IgAN should be treated with immunosuppression. Finally, the variant of overlapping syndrome of IgAN and lipoid nephrosis that runs a good prognosis should be treated as lipoid nephrosis. Key Message: The treatment of IgAN should be structured according to the clinical scenario.

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Treatment of severe IgA nephropathy: mycophenolate mofetil/prednisone compared to cyclophosphamide/prednisone

Cited by 22 publications

References 0 publications

Efficacy and safety of mycophenolate mofetil in patients with IgA nephropathy: an update meta-analysis

Efficacy and safety of mycophenolate mofetil in patients with IgA nephropathy: an update meta-analysis

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

The Treatment of IgA Nephropathy

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