Efficacy and Safety of Tacrolimus Monotherapy Versus Tacrolimus-corticosteroid Combination Therapy for Idiopathic Membranous Nephropathy: A Meta-analysis

Overview

Journal Medicine (Baltimore)

Specialty General Medicine

Date 2021 Dec 23

PMID 34941086

Citations 2

Authors

Lifeng Gong

Min Xu

Wei Xu

Weigang Tang

Jingkui Lu

Wei Jiang

Fengyan Xie

Liping Ding

Xiaoli Qian

Affiliations

Soon will be listed here.

Abstract

Objective: The objective of this meta-analysis was to compare the efficacy and safety of tacrolimus (TAC) monotherapy versus TAC-corticosteroid combination therapy in idiopathic membranous nephropathy (IMN) patients.

Methods: Databases including PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure, and Wanfang database were searched from inception to January 10, 2021. Eligible studies comparing TAC monotherapy and TAC-corticosteroid combination therapy in IMN patients were included. Data were analysed using Review Manager Version 5.3.

Results: Seven studies were included in the meta-analysis. One randomized controlled trial and six cohort studies involving 372 patients were identified. Compared with TAC monotherapy, TAC-corticosteroid had a higher total remission at the sixth month (odd ratio (OR) 0.49, 95% confidence interval (CI) 0.31-0.78, P < .01). The two therapy regimens had similar complete remission rates (OR 0.79, 95% CI 0.43-1.48, P = .47) at the sixth month and similar relapse rates (OR 1.44, 95% CI 0.70-2.92, P = .32). TAC-corticosteroid combination therapy had a higher incidence of infection (OR 0.38, 95% CI 0.18-0.81, P = .01). The two therapy regimens had similar incidences of gastrointestinal symptoms (OR 0.96, 95% CI 0.34-2.70, P = .93), abnormal aminotransferase (OR 0.90, 95% CI 0.34-2.38, P = .84), and glucose intolerance (OR 0.58, 95% CI 0.32-1.07, P = .08).

Conclusion: TAC-corticosteroid combination therapy had a higher total remission rate at the sixth month but had a higher incidence of infection than TAC monotherapy in the treatment of IMN. The two therapeutic regimens had similar relapse rates.

Citing Articles

Calcineurin inhibitors or cyclophosphamide in the treatment of membranous nephropathy superimposed with FSGS lesions: a retrospective study from China.

He H, Huang Y, Liang Q, Ye Q, Li A, Ye K Ren Fail. 2023; 45(2):2253930.

PMID: 37724535 PMC: 10512924. DOI: 10.1080/0886022X.2023.2253930.

Efficacy of low or heavy rituximab‑based protocols and comparison with seven regimens in idiopathic membranous nephropathy: a systematic review and network meta-analysis.

Chen M, Zhang X, Xiong Y, Xu G Int Urol Nephrol. 2022; 55(3):641-651.

PMID: 36161550 DOI: 10.1007/s11255-022-03372-5.

References

Haas M, Meehan S, Karrison T, SPARGO B . Changing etiologies of unexplained adult nephrotic syndrome: a comparison of renal biopsy findings from 1976-1979 and 1995-1997. Am J Kidney Dis. 1997; 30(5):621-31. DOI: 10.1016/s0272-6386(97)90485-6. View

Stang A . Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010; 25(9):603-5. DOI: 10.1007/s10654-010-9491-z. View

Hladunewich M, Troyanov S, Calafati J, Cattran D . The natural history of the non-nephrotic membranous nephropathy patient. Clin J Am Soc Nephrol. 2009; 4(9):1417-22. PMC: 2736692. DOI: 10.2215/CJN.01330209. View

Grimm M, Rinaldi M, Yonan N, Arpesella G, Arizon Del Prado J, Pulpon L . Superior prevention of acute rejection by tacrolimus vs. cyclosporine in heart transplant recipients--a large European trial. Am J Transplant. 2006; 6(6):1387-97. DOI: 10.1111/j.1600-6143.2006.01300.x. View

Choudhry S, Bagga A, Hari P, Sharma S, Kalaivani M, Dinda A . Efficacy and safety of tacrolimus versus cyclosporine in children with steroid-resistant nephrotic syndrome: a randomized controlled trial. Am J Kidney Dis. 2009; 53(5):760-9. DOI: 10.1053/j.ajkd.2008.11.033. View

Debiec H, Guigonis V, Mougenot B, Decobert F, Haymann J, Bensman A . Antenatal membranous glomerulonephritis due to anti-neutral endopeptidase antibodies. N Engl J Med. 2002; 346(26):2053-60. DOI: 10.1056/NEJMoa012895. View

Schieppati A, Mosconi L, Perna A, MECCA G, Bertani T, Garattini S . Prognosis of untreated patients with idiopathic membranous nephropathy. N Engl J Med. 1993; 329(2):85-9. DOI: 10.1056/NEJM199307083290203. View

Shang S, Cai G, Duan S, Li P, Li Q, Chen X . Retrospective analysis of tacrolimus combined with Tripterygium wilfordii polyglycoside for treating idiopathic membranous nephropathy. BMC Nephrol. 2018; 19(1):182. PMC: 6052665. DOI: 10.1186/s12882-018-0967-5. View

Liu D, Yang Y, Kuang F, Qing S, Hu B, Yu X . Risk of infection with different immunosuppressive drugs combined with glucocorticoids for the treatment of idiopathic membranous nephropathy: A pairwise and network meta-analysis. Int Immunopharmacol. 2019; 70:354-361. DOI: 10.1016/j.intimp.2019.03.002. View

10.

Liang Q, Li H, Xie X, Qu F, Li X, Chen J . The efficacy and safety of tacrolimus monotherapy in adult-onset nephrotic syndrome caused by idiopathic membranous nephropathy. Ren Fail. 2017; 39(1):512-518. PMC: 6014322. DOI: 10.1080/0886022X.2017.1325371. View

11.

Chen M, Li H, Li X, Lu F, Ni Z, Xu F . Tacrolimus combined with corticosteroids in treatment of nephrotic idiopathic membranous nephropathy: a multicenter randomized controlled trial. Am J Med Sci. 2010; 339(3):233-8. DOI: 10.1097/MAJ.0b013e3181ca3a7d. View

12.

. Chapter 7: Idiopathic membranous nephropathy. Kidney Int Suppl (2011). 2014; 2(2):186-197. PMC: 4089709. DOI: 10.1038/kisup.2012.20. View

13.

Praga M, Barrio V, Juarez G, Luno J . Tacrolimus monotherapy in membranous nephropathy: a randomized controlled trial. Kidney Int. 2007; 71(9):924-30. DOI: 10.1038/sj.ki.5002215. View

14.

Rauch M, San Martin A, Ojeda D, Quezada C, Salas M, Carcamo J . Tacrolimus causes a blockage of protein secretion which reinforces its immunosuppressive activity and also explains some of its toxic side-effects. Transpl Immunol. 2009; 22(1-2):72-81. DOI: 10.1016/j.trim.2009.07.001. View

15.

Zhang X, Ji C, Yuan J, Wang L, Zhang J, Fang W . Efficacy and safety of tacrolimus-based treatment for nephrotic idiopathic membranous nephropathy in young adults: A retrospective study. Kaohsiung J Med Sci. 2019; 35(10):633-639. DOI: 10.1002/kjm2.12098. View

16.

du Buf-Vereijken P, Branten A, Wetzels J . Idiopathic membranous nephropathy: outline and rationale of a treatment strategy. Am J Kidney Dis. 2005; 46(6):1012-29. DOI: 10.1053/j.ajkd.2005.08.020. View

17.

Qiu T, Zhang C, Zhao H, Zhou J . Calcineurin inhibitors versus cyclophosphamide for idiopathic membranous nephropathy: A systematic review and meta-analysis of 21 clinical trials. Autoimmun Rev. 2016; 16(2):136-145. DOI: 10.1016/j.autrev.2016.12.005. View

18.

He L, Peng Y, Liu H, Liu Y, Yuan S, Liu F . Treatment of idiopathic membranous nephropathy with combination of low-dose tacrolimus and corticosteroids. J Nephrol. 2012; 26(3):564-71. DOI: 10.5301/jn.5000199. View

19.

Zhu L, Liu L, Yao L, Wang L . Efficacy and Safety of Tacrolimus Versus Cyclophosphamide for Primary Membranous Nephropathy: A Meta-Analysis. Drugs. 2017; 77(2):187-199. DOI: 10.1007/s40265-016-0683-z. View

20.

Li Y, Huang J, Li X, Zhao S . A comparison of cyclophosphamide versus tacrolimus in terms of treatment effect for idiopathic membranous nephropathy: A meta-analysis. Nefrologia (Engl Ed). 2019; 39(3):269-276. DOI: 10.1016/j.nefro.2018.10.008. View