Efficacy and Safety of Agents in IgA Nephropathy: An Update Network Meta-Analysis

Abstract

Background/Aims: The present network meta-analysis of randomized controlled trials (RCTs) was to explore the efficacy and safety of different pharmacologic interventions in IgA nephropathy with proteinuria more than 0.75 g/d. Methods: We systematically searched the Cochrane Library, Embase, and PubMed database for studies compared the rate of clinical remission and/or serious adverse events in IgA nephropathy patients with proteinuria (> 0.75 g/d) up to August 1, 2018. We ranked the comparative effects of all drugs against placebo on the surface under the cumulative ranking area (SUCRA) probabilities. Results: There were 29 RCTs comprising 2517 participants included for the comparisons of 9 interventions. The rank of the most effective treatments for inducing clinical remission was renin-angiotensin system inhibitors (RASi) in combination with steroid, tonsillectomy combined with steroid pulse therapy, and azathioprine plus RASi with SUCRA of 82.9%, 80.5%, and 67.6%, respectively. RASi in combination with steroid (SUCRA 3.9%) was the most effective in prevention of end-stage renal disease or doubling serum creatinine, followed by RASi monotherapy (SUCRA 38.4%) and azathioprine combined with steroid (SUCRA 49.0%). As for the occurrence of serious adverse events, azathioprine combined with RASi (SUCRA 88.0%) and steroid plus RASi (SUCRA 74.6%) showed the first and second highest incidence of adverse events, respectively. Conclusion: RASi combined with steroid demonstrated the most effective therapeutic approach for IgA nephropathy patients in terms of reducing proteinuria and stabilizing renal function.

The effectiveness and safety of full-dose versus half-dose corticosteroid plus renin-angiotensin system blockers for IgA nephropathy

“…Hou and colleagues 4 proposed that among RASB + CS had lower risks for worse renal function and long-term renal protection. 7 In our study, the eGFR of only one patient decreased >30% compared with the baseline in the half CS + RASB group, while three patients were observed in the full CS group during the observation period. No patients progressed to ESRD or required renal replacement therapy.…”

“…Several RCTs that have tested the efficacy of a CS regimen compared with a no CS control in IgAN found that full-dose CS resulted in better clinical outcomes in terms of remission and long-term outcomes. 12–14 The network meta-analysis, 7 that included patients with IgAN with 24 h UP >0.75 g/d, demonstrated that RASB + CS was the most effective treatment to prevent ESRD or the doubling of Scr, was effective in reducing proteinuria, and strongly supported the efficacy and long-term renal protective value of RASB + CS treatment.…”

“…This finding supported that patients with IgAN demonstrated a good response to CS. A recent network meta-analysis 7 demonstrated that RASB + CS is probably the best therapeutic choice not only for reducing proteinuria but also for stabilizing renal function. A multicenter randomized control trial (RCT) 4 suggested that mycophenolate mofetil (MMF) + half-dose CS versus full-dose CS did not differ in reducing proteinuria.…”

A non-invasive diagnostic model of immunoglobulin A nephropathy and serological markers for evaluating disease severity

“…Statistics have been applied to determine significant predictors for the diagnosis or classification of various diseases [8] . Subsequently, different statistical algorithms, biological datasets, and parameters may result in different outputs.…”

Comparative efficacy between monoclonal antibodies and conventional drugs in postmenopausal women with osteoporosis: a network meta-analysis

“…This study was conducted according to the PRISMA protocols (15)(16)(17)(18)(19). We systematically searched PubMed, Google Scholar, Embase, and Cochrane Library, as well as China National Knowledge Infrastructure (CNKI), a key national research and information publishing institution in China, for articles up to August 31, 2020, with the restriction of language to English and Chinese.…”