Immunosuppressive treatment for nephrotic idiopathic membranous nephropathy: a meta-analysis based on Chinese adults.

Immunosuppressive treatment for nephrotic idiopathic membranous nephropathy: a meta-analysis based on Chinese adults.

<h4>Background</h4>Idiopathic 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.<h4>Objectives</h4>To assess the...

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Autores principales: Guoqiang Xie, Jing Xu, Chaoyang Ye, Dongping Chen, Chenggang Xu, Li Yang, Yiyi Ma, Xiaohong Hu, Lin Li, Lijun Sun, Xuezhi Zhao, Zhiguo Mao, Changlin Mei
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Publicado: Public Library of Science (PLoS) 2012
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Acceso en línea:https://doaj.org/article/1862f22c771d4d148c04bbaeff4d2c14
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spelling oai:doaj.org-article:1862f22c771d4d148c04bbaeff4d2c142021-11-18T07:06:33ZImmunosuppressive treatment for nephrotic idiopathic membranous nephropathy: a meta-analysis based on Chinese adults.1932-620310.1371/journal.pone.0044330https://doaj.org/article/1862f22c771d4d148c04bbaeff4d2c142012-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/22957065/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>Idiopathic 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.<h4>Objectives</h4>To assess the efficacy and safety of different immunosuppressive agents in the treatment of nephrotic syndrome caused by IMN.<h4>Methods</h4>PubMed, 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.<h4>Main results</h4>17 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).<h4>Conclusions</h4>This 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.Guoqiang XieJing XuChaoyang YeDongping ChenChenggang XuLi YangYiyi MaXiaohong HuLin LiLijun SunXuezhi ZhaoZhiguo MaoChanglin MeiPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 7, Iss 9, p e44330 (2012)
institution DOAJ
collection DOAJ
language EN
topic Medicine
R
Science
Q
spellingShingle Medicine
R
Science
Q
Guoqiang Xie
Jing Xu
Chaoyang Ye
Dongping Chen
Chenggang Xu
Li Yang
Yiyi Ma
Xiaohong Hu
Lin Li
Lijun Sun
Xuezhi Zhao
Zhiguo Mao
Changlin Mei
Immunosuppressive treatment for nephrotic idiopathic membranous nephropathy: a meta-analysis based on Chinese adults.
description <h4>Background</h4>Idiopathic 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.<h4>Objectives</h4>To assess the efficacy and safety of different immunosuppressive agents in the treatment of nephrotic syndrome caused by IMN.<h4>Methods</h4>PubMed, 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.<h4>Main results</h4>17 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).<h4>Conclusions</h4>This 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.
format article
author Guoqiang Xie
Jing Xu
Chaoyang Ye
Dongping Chen
Chenggang Xu
Li Yang
Yiyi Ma
Xiaohong Hu
Lin Li
Lijun Sun
Xuezhi Zhao
Zhiguo Mao
Changlin Mei
author_facet Guoqiang Xie
Jing Xu
Chaoyang Ye
Dongping Chen
Chenggang Xu
Li Yang
Yiyi Ma
Xiaohong Hu
Lin Li
Lijun Sun
Xuezhi Zhao
Zhiguo Mao
Changlin Mei
author_sort Guoqiang Xie
title Immunosuppressive treatment for nephrotic idiopathic membranous nephropathy: a meta-analysis based on Chinese adults.
title_short Immunosuppressive treatment for nephrotic idiopathic membranous nephropathy: a meta-analysis based on Chinese adults.
title_full Immunosuppressive treatment for nephrotic idiopathic membranous nephropathy: a meta-analysis based on Chinese adults.
title_fullStr Immunosuppressive treatment for nephrotic idiopathic membranous nephropathy: a meta-analysis based on Chinese adults.
title_full_unstemmed Immunosuppressive treatment for nephrotic idiopathic membranous nephropathy: a meta-analysis based on Chinese adults.
title_sort immunosuppressive treatment for nephrotic idiopathic membranous nephropathy: a meta-analysis based on chinese adults.
publisher Public Library of Science (PLoS)
publishDate 2012
url https://doaj.org/article/1862f22c771d4d148c04bbaeff4d2c14
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