Efficacy and safety of different treatments for moderate to severe Henoch-Schönlein purpura nephritis：a network meta-analysis
- VernacularTitle:不同方式治疗中重度过敏性紫癜肾炎有效性与安全性的网状Meta分析
- Author:
Ziyi LI
1
;
Bingru WANG
1
;
Wanmei GAO
1
;
Xiaochun ZHOU
1
,
2
,
3
,
4
;
Jianqin WANG
1
,
2
,
3
Author Information
1. The Second Hospital & Clinical Medical School，Lanzhou University，Lanzhou 730030，China
2. Department of Nephrology，the Second Hospital & Clinical Medical School，Lanzhou University，Lanzhou 730030，China
3. Key Laboratory of Nephropathy，the Second Hospital & Clinical Medical School，Lanzhou University，Lanzhou 730030，China
4. Gansu Clinical Medical Research Center of Nephropathy，Lanzhou 730030，China
- Publication Type:Journal Article
- Keywords:
Henoch-schönlein purpura nephritis;
glucocorticoid;
immunosuppressant;
network meta-analysis;
efficacy;
safety
- From:
China Pharmacy
2024;35(22):2808-2814
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVE To assess the efficacy and safety of different treatment modalities for moderate to severe Henoch- Schönlein purpura nephritis （HSPN）. METHODS Literature searches were conducted in the CNKI， VIP， Wanfang Data， SinoMed， PubMed， OVID， Web of Science， Embase， and the Cochrane Library to collect randomized controlled trials （RCTs） and cohort studies on the treatment of moderate to severe HSPN with 12 intervention measures： monotherapy with glucocorticoid （GC）， as well as cyclophosphamide， mycophenolate mofetil （MMF）， Tripterygium wilfordii multiglucoside （TWM）， leflunomide， mizoribine， tacrolimus， cyclosporin A， hemoperfusion， tonsillectomy combined with GC， and double filtration plasmapheresis （DFPP） combined with GC and cyclophosphamide or mycophenolate mofetil. The search period was from the inception of the databases to March 2024. After literature screening， data extraction， and quality assessment， a network meta- analysis was performed using Stata 16.0 software. RESULTS A total of 28 articles were included， with 14 RCTs and 14 cohort studies， involving 1 746 patients. The network meta-analysis results showed the combination of tacrolimus and GC had the highest probability of being the best in overall remission rate， followed by the combination of TWM and GC， and DFPP combined with GC and MMF. The combination of leflunomide and GC had the highest probability of being the best in complete remission rate， followed by the combination of mizoribine and GC， and DFPP combined with GC and cyclophosphamide. The combination of mizoribine and GC had the highest probability of being the best in terms of reducing 24-hour urinary protein quantification， followed by DFPP combined with GC and MMF， and the combination of leflunomide and GC. Moreover， the combination of tacrolimus and GC had the highest probability of being the best in safety， followed by the combination of cyclosporin A and GC， and the combination of leflunomide and GC. CONCLUSIONS Compared to other treatment methods， the combination therapy of tacrolimus and GC shows better efficacy and safety in the treatment of moderate to severe HSPN.
