Meta-analysis of corticosteroid therapy for IgA nephropathy / 中国医师杂志

ABSTRACT

Objective To evaluate the efficiency and safety of corticosteroid therapy for IgA nephropathy.Methods Pubmed,Medline/embase,and Te Cochrane Library databases were searched for randomized controlled trials (RCTs) of hormone therapy for IgA nephropathy from database establishment to September 2017.According to the Cochrane system evaluation method,two reviewers independently screened the literature,extracted data,evaluated the quality of the included studies and cross-checked them according to inclusion and exclusion criteria.The Cochrane bias risk method was used to evaluate the quality of the included studies.The fixed effect model was used to assess the risk of serum creatinine change and progression to end-stage renal disease (ESRD).The random-effect models were used to assess 24-hour urinary protein quantification and the incidence of adverse events leading to drug withdrawal or hospitalization.The data were pooled using RevMan 5.3 software.The quadratic variables were odds ratio (OR) and the continuous variables were mean difference (MD).The odds ratio was used as the effect variable for the two variables,and the mean variance was used as the effect variable for the continuous variable data.Results A total of 9 RCTs were enrolled.Meta-analysis showed that compared with the control group,the steroid treatment group could slow down the increase of serum creatinine by more than 50％ in IgA nephropathy patients (OR =0.15,95％ CI0.04-0.53,P =0.003) and delay the progression to ESRD (OR =0.38,95％ CI0.16-0.87,P =0.02),but there was no significant difference in the level of serum creatinine (MD =-0.03,95％ CI-0.29-0.24,P =0.85),the 24 hour urinary protein quantification (MD =-0.55,95％ CI-1.42-0.31,P =0.21),and the incidence of adverse reactions (OR =1.68,95％ CI0.69-4.11,P =0.26).Conclusions The meta analysis showed that there was no significant difference in the safety of steroid treated IgA nephropathy compared with the control group,and may be beneficial to the long-term prognosis of patients with IgA nephropathy.