Department of Nephrology, The Affiliated People's Hospital of Ningbo University, Ningbo, China.
Ann Palliat Med. 2021 Nov;10(11):11830-11839. doi: 10.21037/apm-21-2883.
Immunoglobulin A (IgA) nephropathy is an immune complex-mediated glomerulonephritis; however, the role of immunosuppression is still controversial, and there is a lack of studies on the long-term efficacy of immunosuppressive drugs in the treatment of the disease. We conducted a meta-analysis to examine the long-term effects of immunosuppressive drugs.
To identify random control trial articles on immunosuppressive drugs in the treatment of IgA nephropathy with a follow-up time >3 years, the following databases were searched: MEDLINE (1946 to August 2021), EMBASE (2000 to August 2021), PubMed (2000 to August 2021), and Cochrane library (2000 to August 2021). After screening, the Cochrane Handbook of Systematic Reviews of Interventions was used to examine the bias of the studies, Stata16.0 software was used for the analysis, and forest plots were used to present the results.
A total of 744 patients from 7 studies were included in the study. The results of the meta-analysis showed that the long-term renal function integrity rate in the experimental group treated with immunosuppressive drugs was higher than that in the control group treated with placebos [risk ratio (RR) =1.10, 95% confidence interval (CI): 1.00, 1.22, Z=1.978, P=0.048], the efficacy of immunosuppressive drugs during the 3-6-year follow-up period (RR =1.07, 95% CI: 0.92, 1.23, Z=0.864, P=0.388) was similar to that of immunosuppressive drugs during the 8-10-year follow-up period (RR =1.14, 95% CI: 1.00, 1.30, Z=1.909, P=0.056), the efficacy of immunosuppressive drug therapy alone (RR =1.11, 95% CI: 1.00, 1.24, Z=1.914, P=0.056) was similar to that of immunosuppressive combination drug therapy (RR =1.07, 95% CI: 0.84, 1.35, Z=0.549, P=0.583), and the adverse reactions in the immunosuppressive drug group were higher than those in the placebo group (RR =1.59, 95% CI: 1.38, 1.85, Z=6.230, P=0.000).
The use of immunosuppressive drugs can improve the long-term effects of IgA nephropathy treatment, but consideration should be given to the increase of adverse reactions during treatment.
免疫球蛋白 A（IgA）肾病是一种免疫复合物介导的肾小球肾炎；然而，免疫抑制的作用仍存在争议，并且缺乏关于免疫抑制剂治疗该病的长期疗效的研究。我们进行了一项荟萃分析，以研究免疫抑制剂的长期疗效。
为了确定随访时间>3 年的 IgA 肾病免疫抑制剂治疗的随机对照试验文章，检索了以下数据库：MEDLINE（1946 年至 2021 年 8 月）、EMBASE（2000 年至 2021 年 8 月）、PubMed（2000 年至 2021 年 8 月）和 Cochrane 图书馆（2000 年至 2021 年 8 月）。筛选后，使用 Cochrane 干预措施系统评价手册检查研究偏倚，使用 Stata16.0 软件进行分析，并使用森林图呈现结果。
共有 7 项研究的 744 名患者纳入本研究。荟萃分析结果显示，实验组接受免疫抑制剂治疗的长期肾功能完整率高于对照组接受安慰剂治疗的患者[风险比（RR）=1.10，95%置信区间（CI）：1.00，1.22，Z=1.978，P=0.048]，实验组在 3-6 年随访期间的疗效（RR=1.07，95%CI：0.92，1.23，Z=0.864，P=0.388）与实验组在 8-10 年随访期间的疗效相似（RR=1.14，95%CI：1.00，1.30，Z=1.909，P=0.056），免疫抑制剂单药治疗的疗效（RR=1.11，95%CI：1.00，1.24，Z=1.914，P=0.056）与免疫抑制剂联合药物治疗的疗效相似（RR=1.07，95%CI：0.84，1.35，Z=0.549，P=0.583），免疫抑制剂组的不良反应发生率高于安慰剂组（RR=1.59，95%CI：1.38，1.85，Z=6.230，P=0.000）。
使用免疫抑制剂可以改善 IgA 肾病治疗的长期效果，但应考虑治疗期间不良反应的增加。
