The long-term efficacy and safety of immunosuppressive therapy on the progression of IgA nephropathy: a meta-analysis of controlled clinical trials with more than 5-year follow-up. (June 2015)

• Record Type: Journal Article
• Authors: Tian, Lei; Shao, Xinghua; Xie, Yuanyuan; Wang, Ling; Wang, Qin; Che, Xiajing; Ni, Zhaohui; Mou, Shan
• Is Part Of: Expert opinion on pharmacotherapy. Volume 16:Number 8(2015)
• Page Start: 1137
• Page End: 1147
• Publication Date: 2015-06
• Subjects: Chemotherapy -- Periodicals; 615.5805
• DOI: 10.1517/14656566.2015.1038238
• Languages: English
• ISSNs: 1465-6566

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <p> <italic> <bold>Objective:</bold> </italic> To evaluate the long-term efficacy of immunosuppressive therapy on Immunoglobulin A nephropathy (IgAN).</p> <p> <italic> <bold>Methods:</bold> </italic> Trials with at least 5-year follow-up investigating immunosuppressive therapy were selected.</p> <p> <bold> <italic>Main outcome measures:</italic> </bold> Primary outcome was end-stage renal disease (ESRD). Secondary outcome was deterioration in renal function defined as doubled serum creatinine or 50% reduction of eGFR.</p> <p> <italic> <bold>Results:</bold> </italic> Seven studies were enrolled. Immunosuppression lowered the risk for ESRD risk ratio (RR = 0.30, 95% CI 0.19 – 0.48, p < 0.00001) and deterioration in renal function (RR = 0.19, 95% CI 0.07 – 0.54, p = 0.002). As for pooled RRs of ESRD, there were four studies with < 7-year follow-up, three followed for > 7 years, four adopted corticosteroids, two used corticosteroids plus other immunosuppressive agents, four were from Asia, and three from Europe. Pooled RRs were 0.32 (95% CI, 0.18 – 0.58, p = 0.0001), 0.28 (95% CI, 0.13 – 0.59, p = 0.0009), 0.34 (95% CI, 0.17 – 0.67, p = 0.002), 0.29 (95% CI, 0.15 – 0.58, p = 0.0005), 0.37 (95% CI, 0.20 – 0.68, p = 0.001) and 0.23 (95% CI, 0.11 – 0.47, p < 0.0001), respectively. Immunosuppression was associated with an increased risk for adverse events (RR = 2.13, 95% CI 1.17 – 3.86, p = 0.01).</p> <p> <italic> <bold>Conclusions:</bold> </italic> Immunosuppressive therapy for IgAN might reduce long-term risk of ESRD and deterioration in renal function but increase risk of adverse events, and the efficacy on patients from Europe and Asia might be similar. Addition of other immunosuppressive agents did not provide additional benefit.</p> </abstract>