Efficacy and safety of immunosuppressive agent monotherapy for IgA nephropathy: a network meta-analysis [post]

2020 unpublished
The efficacy and safety of immunosuppressive agent monotherapy were evaluated for Immunoglobulin A nephropathy (IgAN) using a network meta-analysis approach based on randomised controlled trials (RCTs). Methods PubMed, Embase, the Cochrane library, and the Web of Science were systematically searched for RCTs published before October 2019 using immunosuppressive agents for treating IgAN. Quality assessments were performed according to the Cochrane Handbook. Pooled relative risks (RRs) or
more » ... ks (RRs) or standard mean differences (SMDs) with corresponding 95% confidence intervals (CIs) were calculated for discrete or continuous variables, respectively. The primary outcomes were clinical remission, endstage renal disease (ESRD), and serious adverse events (SAEs); the secondary outcomes were urinary protein excretion and serum creatinine. Data were synthesised by the random-effects model. Results Twenty-five RCTs with 2005 participants were deemed to be eligible, and six medications were evaluated: corticosteroids, mycophenolate mofetil (MMF), tacrolimus (TAC), cyclosporine (CsA), leflunomide (LEF), and hydroxychloroquine (HCQ). Compared to supportive care alone, steroids (RR 1.50, 95% CI 1.17-1.93), MMF (RR 2.05, 95% CI 1.15-3.65), TAC (RR 3.67, 95% CI 1.06-12.63), and HCQ (RR 3.25, 95% CI 1.05-10.09) each significantly improved clinical remission rates; only steroids reduced the risk of ESRD (RR 0.35, 95% CI 0.12-0.98), but the SAEs were significantly higher than those in the control group (RR 2.90, 95% CI 1.37-6.13). Furthermore, steroids, LEF, and HCQ showed lower proteinuria in the pairwise meta-analysis. There was no evidence of different effects of the therapies on serum creatinine levels. The effect of MMF, whereby it induced remission, was reversed when excluding studies with follow-up of fewer than two years in the sensitivity analysis (RR 1.41,). The anti-proteinuric effect of TAC was reversed three months after discontinuing medication; the long-term effects of HCQ could not be evaluated due to the short follow-up. Conclusions 3 Corticosteroids might induce remission and increase renal survival in IgAN; however, the adverse reactions should be considered. TAC, LEF, HCQ, and MMF, might improve remission of proteinuria when treating IgAN, but showed no superiority compared to steroids, and the long-term effects require further study.
doi:10.21203/rs.2.20258/v1 fatcat:a7oume4qi5dkjixfr7ijwa5kqe