The efficacy and safety of immunosuppressive therapies in the treatment of IgA nephropathy: A network meta-analysis

• Published in: Scientific reports 2020-04, Vol.10 (1), p.6062, Article 6062
• Main Authors: Tan, Jiaxing, Dong, Lingqiu, Ye, Donghui, Tang, Yi, Hu, Tengyue, Zhong, Zhengxia, Tarun, Padamata, Xu, Yicong, Qin, Wei
• Format: Article
• Language: English
• Subjects: 692/4022/1585/1681; 692/4022/1585/2759; Adult; Azathioprine - administration & dosage; Azathioprine - adverse effects; Azathioprine - therapeutic use; Bayesian analysis; Bias; Clinical Trials as Topic; Confidence intervals; Drug Combinations; End-stage renal disease; Female; Glomerulonephritis; Glomerulonephritis, IGA - drug therapy; Glucocorticoids - administration & dosage; Glucocorticoids - adverse effects; Glucocorticoids - therapeutic use; Humanities and Social Sciences; Humans; IgA nephropathy; Immunoglobulin A; Immunoglobulins; Immunosuppressive agents; Immunosuppressive Agents - administration & dosage; Immunosuppressive Agents - adverse effects; Immunosuppressive Agents - therapeutic use; Kidney diseases; Male; Meta-analysis; Middle Aged; multidisciplinary; Mycophenolic Acid - administration & dosage; Mycophenolic Acid - adverse effects; Mycophenolic Acid - therapeutic use; Proteinuria; Renal function; Risk assessment; Science; Science (multidisciplinary); Side effects; Steroid hormones; Steroids; Systematic review; Tacrolimus; Tacrolimus - administration & dosage; Tacrolimus - adverse effects; Tacrolimus - therapeutic use; Treatment Outcome
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-020-63170-w

Immunoglobulin A nephropathy (IgAN) is a common autoimmune glomerulonephritis that can result in end-stage renal disease (ESRD). Whether immunosuppressants are superior or equivalent to supportive care is still controversial. A network meta-analysis was conducted to compare the efficacy and safety of immunosuppressive treatment for IgAN. Medline, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and EMBASE were searched on December 30, 2018. We used a random-effects model with a Bayesian approach to appraise both renal outcomes and serious adverse effects. Relative risks (RRs) with 95% confidence intervals (CIs) were calculated to present the relative effects. The ranking probabilities were calculated by the surface under the cumulative ranking curve (SUCRA). In total, 24 RCTs comprising 6 interventions were analyzed. Steroids significantly delayed the progression of renal deterioration with acceptable serious adverse effects, compared with supportive care (RR = 0.28, 95% CI = 0.13–0.51, SUCRA = 48.7%). AZA combined with steroids might be an alternative immunosuppressive therapy. Tacrolimus might decrease the proteinuria level (RR = 3.1, 95% CI = 1.2–9.4, SUCRA = 66.5%) but cannot improve renal function, and the side effects of tacrolimus should not be neglected. MMF and CYC showed no superiority in the treatment of IgAN. In summary, steroids might be recommended as the first-line immunosuppressive therapy for IgAN.