Meta analysis for the long-term efficacy and safety of immunosuppression on the progression of IgA nephropathy / 中华肾脏病杂志

ABSTRACT

Objective To access the long-term efficacy and safety of immunosuppression on the progression of IgA nephropathy (IgAN) by Meta analysis.Methods Databases EMBASE,Pubmed,Elsevier Science Direct,Scopus,Web of Science,Google Scholar,Cochrane Library,China National Knowledge Infrastructure,WanFang and VIP Data were retrieved to collect the randomized controlled trials (RCTs) at least 3 years follow-up on immunosuppression for IgAN published before May 2014.The literatures were screened independently by two reviewers according to the inclusion and exclusion criteria,and the methodological quality was assessed.Statistic software Stata 12.0 was used to conduct analysis.Results Nine articles were included in this study with a total of 568 patients.Immurnosuppression could lowered the risk for the progression to ESRD (RR=0.32,95％CI0.20-0.49,P ＜ 0.01).As far as the efficacy of immunosuppression,subgroup analysis indicated that three studies with more than 7 year follow-up (RR=0.28,95％CI0.13-0.59,P ＜ 0.01) were similar with 7 studies followed by for less than 7 years (RR=0.34,95％ CI0.19-0.59,P＜0.01); six adopted immunosuppressor monotherapy (RR=0.29,95％ CI0.15-0.58,P＜ 0.01) were similar to two used corticosteroids plus other immunosuppression (RR=0.33,95％CI0.18-0.59,P ＜ 0.01); There were no significant differences between four studies from Europe (RR=0.27,95％CI0.14-0.53,P ＜ 0.01) and five from Asia (RR=0.35,95％ CI0.19-0.65,P＜0.01).Immunosuppression was associated with an increased risk for adverse events (RR=2.33,95％ CI1.33-4.09,P＜0.01).Conclusion Immunosuppression for IgAN may reduce long-term risk of progression to ESRD,but increase the risk of adverse events to some extent.