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2018 ; 3
(4
): 794-803
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Comparative Efficacy and Safety of Therapies in IgA Nephropathy:
A Network Meta-analysis of Randomized Controlled Trials
#MMPMID29989013
Yang P
; Zou H
; Xiao B
; Xu G
Kidney Int Rep
2018[Jul]; 3
(4
): 794-803
PMID29989013
show ga
The present study aims to compare the relative efficacy and safety of different
interventions for IgA nephropathy (IgAN) with proteinuria more than 1 g/d by
using network meta-analysis. We searched PubMed, Embase, and the Cochrane Library
for studies compared the rate of clinical remission and/or end-stage renal
disease (ESRD) and/or serious adverse events in IgAN patients with proteinuria
(>1 g/d). The surface under the cumulative ranking area (SUCRA) was calculated to
rank the interventions. A total of 21 randomized controlled trials with 1822
participants were included for the comparisons of 7 interventions. The rank of
the most effective treatments to induce clinical remission was renin-angiotensin
system inhibitors (RASi) plus urokinase, steroid plus tonsillectomy, and RASi
plus steroid with a SUCRA of 0.912, 0.710, and 0.583, respectively. As for the
prevention of ESRD or doubling of serum creatinine, RASi plus steroid (SUCRA
0.012) was the most effective, followed by RASi (SUCRA 0.282) and steroid (SUCRA
0.494), leaving mycophenolate mofetil as the least effective (SUCRA 0.644). There
was no statistical difference among all interventions in the occurrence of
serious adverse events. The current network meta-analysis demonstrated for the
first time that RASi plus steroid is probably the best therapeutic choice, not
only for reducing proteinuria but also for maintaining long-term renal
protection.