Feng Chengcheng, Chen Xuexun, Wang Xiangming, Guo Min, Guo Zhentao
School of Clinical Medicine, Shandong Second Medical University, Weifang, China.
Department of Nephrology, School of Clinical Medicine, Affiliated Hospital of Shandong Second Medical University, Shandong Second Medical University, Weifang, China.
Front Pharmacol. 2024 Nov 27;15:1480638. doi: 10.3389/fphar.2024.1480638. eCollection 2024.
This review systematically evaluates the efficacy and safety of the combined treatment of glucocorticoids (GC) and cyclophosphamide (CTX) in patients with membranous nephropathy (MN).
As of June 2024, a comprehensive literature search was performed utilizing several reputable databases, including PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure (CNKI), and Wanfang. A meta-analysis was then carried out using Review Manager 5.4 and STATA/SE-15 software.
This research evaluated a total of 22 articles involving 1,971 patients. The findings revealed that patients with MN receiving combined GC and CTX therapy had significantly higher complete remission rates (odds ratio = 1.78, = 0.02) and total remission rates (odds ratio = 2.14, = 0.01) when the follow-up period exceeded 12 months. Additionally, this treatment demonstrated greater efficacy in lowering serum creatinine levels compared to the control group (standardized mean difference = -0.19, = 0.04), while its relapse rate was also lower than that of the control group (odds ratio = 0.51, = 0.009). However, it has a high incidence of serious adverse effects (odds ratio = 2.32, = 0.03).
Our systematic review highlights that the combination of GC and CTX demonstrates superior long-term effectiveness and reduced relapse rates in managing membranous nephropathy (MN). Furthermore, this drug combination is considered the optimal choice for normalizing serum creatinine levels. Data on the effectiveness and safety of glucocorticoids alone versus other drugs alone, and the treatment of secondary membranous nephropathy (SMN), are limited.
https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=566477, identifier CRD42024566477.
本综述系统评价糖皮质激素（GC）联合环磷酰胺（CTX）治疗膜性肾病（MN）患者的疗效和安全性。
截至2024年6月，利用多个著名数据库进行全面的文献检索，包括PubMed、Embase、Cochrane图书馆、中国知网（CNKI）和万方。然后使用Review Manager 5.4和STATA/SE - 15软件进行荟萃分析。
本研究共评估了22篇文章，涉及1971例患者。研究结果显示，接受GC联合CTX治疗的MN患者在随访期超过12个月时，完全缓解率（比值比 = 1.78，P = 0.02）和总缓解率（比值比 = 2.14，P = 0.01）显著更高。此外，与对照组相比，该治疗在降低血清肌酐水平方面显示出更大的疗效（标准化均数差 = -0.19，P = 0.04），而其复发率也低于对照组（比值比 = 0.51，P = 0.009）。然而，其严重不良反应的发生率较高（比值比 = 2.32，P = 0.03）。
我们的系统评价强调，GC和CTX联合使用在治疗膜性肾病（MN）方面显示出卓越的长期疗效和降低的复发率。此外，这种药物组合被认为是使血清肌酐水平正常化的最佳选择。关于单独使用糖皮质激素与单独使用其他药物以及继发性膜性肾病（SMN）治疗的有效性和安全性的数据有限。
https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=566477，标识符CRD42024566477。
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