Key Laboratory of Microecology-immune Regulatory Network and Related Diseases, School of Basic Medicine, Jiamusi University, Jiamusi, Heilongjiang Province, China.
Department of Urology, Jiamusi Central Hospital, Jiamusi, China.
Ren Fail. 2022 Dec;44(1):1011-1025. doi: 10.1080/0886022X.2022.2085576.
We performed a meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy and safety of leflunomide combined with corticosteroids, compared with corticosteroids alone, for IgA nephropathy.
Studies were retrieved by searching of PubMed, Embase, Cochrane's Library, China National Knowledge Infrastructure (CNKI), and Wanfang databases on 11 October 2021. A random-effect model incorporating the heterogeneity was used to pool the results. The efficacy outcomes included the complete remission rate of proteinuria, overall response rate (the combined rates of patients with complete and partial remission of proteinuria), changes of urine protein excretion (UPE), serum creatinine (SCr), and estimated glomerular infiltrating rate (eGFR).
Nineteen studies were included. Patients receiving the combined therapy had a higher complete remission rate (relative risk [RR]: 1.29, 95% CI: 1.08-1.55, = 0.006; = 0%) and overall response rate (RR: 1.18, 95% CI: 1.10-1.26, < 0.001, = 0%) compared to patients who received CS alone. Besides, combined therapy was associated with significantly reduced levels of UPE (mean difference [MD]: -0.30 g/24h, 95% CI: -0.43 to -0.16, < 0.001; = 34%) and SCr (MD: -7.55 mmol/L, 95% CI: -11.06 to -4.04, < 0.001; = 34%), and increased level of eGFR (MD: 6.51 mL/min/1.73 m, 95% CI: 4.06-8.97, < 0.001; = 0%). The incidence of adverse events was not significantly different.
Combined treatment with leflunomide and corticosteroids was more effective than corticosteroids alone for patients with IgA nephropathy.
我们进行了一项荟萃分析，以评估来氟米特联合皮质类固醇与单独使用皮质类固醇治疗 IgA 肾病的疗效和安全性。
我们于 2021 年 10 月 11 日检索了 PubMed、Embase、Cochrane 图书馆、中国知网（CNKI）和万方数据库，以寻找相关研究。采用随机效应模型合并异质性后对结果进行汇总。疗效结局包括蛋白尿完全缓解率、总缓解率（蛋白尿完全缓解和部分缓解患者的综合缓解率）、尿蛋白排泄量（UPE）、血清肌酐（SCr）和估算肾小球滤过率（eGFR）的变化。
共纳入 19 项研究。与单独接受 CS 治疗的患者相比，接受联合治疗的患者蛋白尿完全缓解率（RR：1.29，95%CI：1.08-1.55， = 0.006； = 0%）和总缓解率（RR：1.18，95%CI：1.10-1.26， < 0.001， = 0%）更高。此外，联合治疗与 UPE 水平显著降低（MD：-0.30 g/24h，95%CI：-0.43 至-0.16， < 0.001； = 34%）和 SCr 水平显著降低（MD：-7.55 mmol/L，95%CI：-11.06 至-4.04， < 0.001； = 34%），eGFR 水平显著升高（MD：6.51 mL/min/1.73 m，95%CI：4.06-8.97， < 0.001； = 0%）相关。不良事件的发生率无显著差异。
来氟米特联合皮质类固醇治疗 IgA 肾病患者的疗效优于单独使用皮质类固醇。
