PDF(Pubmed)
Abstract：
OBJECTIVE: The effectiveness of immunosuppressive and corticosteroid treatments for Immunoglobulin A (IgA) nephropathy (IgAN) remains thoroughly evaluated. We undertook a meta-analysis to investigate the efficacy and safety of low-dose corticosteroids plus leflunomide for progressive IgA nephropathy.
METHODS: Eligible studies were obtained from PubMed, Embase, and Cochrane Library databases. We also searched the references of the included studies. Our protocol followed the preferred reporting items for systematic reviews and meta-analyses (PRISMA) checklist. Eligibility criteria were defined using a PICOS framework.
RESULTS: Our study included three articles presenting 342 patient cases. Findings revealed that low-dose corticosteroids combined with the leflunomide group were effective in relieving urine protein excretion (UPE) [mean difference (MD) = -0.35, 95% confidence interval (CI): -0.41 to -0.30, P < 0.00001] compared with the full-dose corticosteroids group. Regarding serum creatinine (SCr), estimated glomerular filtration rate (eGFR), complete remission rate, and overall response rate, there was no difference between the groups (p > 0.05). Regarding safety, low-dose corticosteroids combined with leflunomide significantly reduced the risk of serious adverse events [odds ratio (OR): 0.11, 95% CI: 0.01 to 0.91, P = 0.04]. Besides, no significant differences were observed between the two groups in the incidence of respiratory infection, abnormal liver function, diarrhea, herpes zoster, alopecia, pruritus, insomnia, pneumonia, diabetes, and urinary tract infection (P > 0.05).
CONCLUSIONS: Low-dose corticosteroids combined with leflunomide are a safe and effective treatment for progressive IgA nephropathy.
BACKGROUND: The PROSPERO registration number is CRD42022361883.
METHODS: Eligible studies were obtained from PubMed, Embase, and Cochrane Library databases. We also searched the references of the included studies. Our protocol followed the preferred reporting items for systematic reviews and meta-analyses (PRISMA) checklist. Eligibility criteria were defined using a PICOS framework.
RESULTS: Our study included three articles presenting 342 patient cases. Findings revealed that low-dose corticosteroids combined with the leflunomide group were effective in relieving urine protein excretion (UPE) [mean difference (MD) = -0.35, 95% confidence interval (CI): -0.41 to -0.30, P < 0.00001] compared with the full-dose corticosteroids group. Regarding serum creatinine (SCr), estimated glomerular filtration rate (eGFR), complete remission rate, and overall response rate, there was no difference between the groups (p > 0.05). Regarding safety, low-dose corticosteroids combined with leflunomide significantly reduced the risk of serious adverse events [odds ratio (OR): 0.11, 95% CI: 0.01 to 0.91, P = 0.04]. Besides, no significant differences were observed between the two groups in the incidence of respiratory infection, abnormal liver function, diarrhea, herpes zoster, alopecia, pruritus, insomnia, pneumonia, diabetes, and urinary tract infection (P > 0.05).
CONCLUSIONS: Low-dose corticosteroids combined with leflunomide are a safe and effective treatment for progressive IgA nephropathy.
BACKGROUND: The PROSPERO registration number is CRD42022361883.
摘要：
目的：免疫抑制和皮质类固醇治疗免疫球蛋白A（IgA）肾病（IgAN）的有效性仍需全面评估。我们进行了一项荟萃分析，以研究低剂量皮质类固醇联合来氟米特治疗进行性IgA肾病的疗效和安全性。
方法：符合条件的研究来自PubMed，Embase,和Cochrane图书馆数据库。我们还检索了纳入研究的参考文献。我们的方案遵循系统评价和荟萃分析（PRISMA）清单的首选报告项目。使用PICOS框架定义合格标准。
结果：我们的研究包括三篇文章，提供342例患者病例。结果表明，小剂量糖皮质激素联合来氟米特组可有效缓解尿蛋白排泄（UPE）[平均差异（MD）=-0.35，95％置信区间（CI）：-0.41至-0.30，P<0.00001]与全剂量糖皮质激素组相比。关于血清肌酐（SCr），估计肾小球滤过率(eGFR)，完全缓解率,和总体反应率，组间无差异(p>0.05)。关于安全,小剂量皮质类固醇联合来氟米特可显著降低严重不良事件的风险[比值比(OR):0.11,95%CI:0.01~0.91,P=0.04].此外,两组呼吸道感染发生率无显著差异,肝功能异常,腹泻,带状疱疹,脱发,瘙痒,失眠,肺炎,糖尿病,尿路感染(P>0.05)。
结论：小剂量糖皮质激素联合来氟米特治疗进展性IgA肾病安全有效。
背景：PROSPERO注册号为CRD42022361883。
方法：符合条件的研究来自PubMed，Embase,和Cochrane图书馆数据库。我们还检索了纳入研究的参考文献。我们的方案遵循系统评价和荟萃分析（PRISMA）清单的首选报告项目。使用PICOS框架定义合格标准。
结果：我们的研究包括三篇文章，提供342例患者病例。结果表明，小剂量糖皮质激素联合来氟米特组可有效缓解尿蛋白排泄（UPE）[平均差异（MD）=-0.35，95％置信区间（CI）：-0.41至-0.30，P<0.00001]与全剂量糖皮质激素组相比。关于血清肌酐（SCr），估计肾小球滤过率(eGFR)，完全缓解率,和总体反应率，组间无差异(p>0.05)。关于安全,小剂量皮质类固醇联合来氟米特可显著降低严重不良事件的风险[比值比(OR):0.11,95%CI:0.01~0.91,P=0.04].此外,两组呼吸道感染发生率无显著差异,肝功能异常,腹泻,带状疱疹,脱发,瘙痒,失眠,肺炎,糖尿病,尿路感染(P>0.05)。
结论：小剂量糖皮质激素联合来氟米特治疗进展性IgA肾病安全有效。
背景：PROSPERO注册号为CRD42022361883。
