Bao Neng, Gu Mingjia, Yu Xiang, Wang Jin, Gao Leiping, Miao Zhiwei, Kong Wei
Department of Nephrology, Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, 157 Daming Road, Nanjing City, Jiangsu, 210000, PR China.
Department of Nephrology, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, 6 Huanghe Road, Changshu City, Jiangsu, 215500, PR China.
Open Life Sci. 2023 Jan 10;18(1):20220527. doi: 10.1515/biol-2022-0527. eCollection 2023.
This network meta-analysis (NMA) aims to investigate the efficacy and safety of different pharmacological treatments for idiopathic membranous nephropathy (IMN). Thirty-four relevant studies were extracted from PubMed, Embase, Cochrane database, and MEDLINE. Treatment with tacrolimus (TAC), cyclophosphamide (CTX), mycophenolate mofetil, chlorambucil (CHL), cyclosporin A (CSA), steroids, rituximab (RTX), and conservative therapy were compared. Outcomes were measured using remission rate and incidence of side effects. Summary estimates were expressed as the odds ratio (OR) and 95% confidence intervals (CIs). The quality of findings was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation approach. In the direct meta-analysis for comparison of complete remission (CR) rate, the curative effect of RTX is inferior to CTX (OR 0.37; CI 0.18, 0.75). In the NMA of CR rate, the results showed that the curative effects of CTX, CHL, and TAC were significantly higher than those of the control group. The efficacy of RTX is not inferior to the CTX (OR 0.81; CI 0.32, 2.01), and the level of evidence was moderate; CSA was not as effective as RTX, and the difference was statistically significant with moderate evidence (OR 2.98, CI 1.00, 8.91). In summary, we recommend CTX and RTX as the first-line drug for IMN treatment.
这项网络荟萃分析（NMA）旨在研究不同药物治疗特发性膜性肾病（IMN）的疗效和安全性。从PubMed、Embase、Cochrane数据库和MEDLINE中提取了34项相关研究。比较了他克莫司（TAC）、环磷酰胺（CTX）、霉酚酸酯、苯丁酸氮芥（CHL）、环孢素A（CSA）、类固醇、利妥昔单抗（RTX）和保守治疗的效果。使用缓解率和副作用发生率来衡量结果。汇总估计值以比值比（OR）和95%置信区间（CIs）表示。采用推荐分级、评估、制定和评价方法对研究结果的质量进行评估。在直接荟萃分析中比较完全缓解（CR）率时，RTX的疗效低于CTX（OR 0.37；CI 0.18，0.75）。在CR率的NMA中，结果显示CTX、CHL和TAC的疗效显著高于对照组。RTX的疗效不低于CTX（OR 0.81；CI 0.32，2.01），证据水平为中等；CSA不如RTX有效，差异具有统计学意义，证据水平为中等（OR 2.98，CI 1.00，8.91）。总之，我们推荐CTX和RTX作为IMN治疗的一线药物。
