Efficacy and Safety of Low-dose Corticosteroids Combined with Leflunomide for Progressive IgA Nephropathy: a Systematic Review and Meta-analysis

Overview

Journal BMC Urol

Publisher Biomed Central

Specialty Urology

Date 2024 Mar 12

PMID 38468247

Authors

Dongxu Zhang

Bowen Xia

Xin Zhang

Pu Liang

Xiaopeng Hu

Affiliations

Soon will be listed here.

Abstract

Background And Objective: The effectiveness of immunosuppressive and corticosteroid treatments for Immunoglobulin A (IgA) nephropathy (IgAN) remains thoroughly evaluated. We undertook a meta-analysis to investigate the efficacy and safety of low-dose corticosteroids plus leflunomide for progressive IgA nephropathy.

Methods: Eligible studies were obtained from PubMed, Embase, and Cochrane Library databases. We also searched the references of the included studies. Our protocol followed the preferred reporting items for systematic reviews and meta-analyses (PRISMA) checklist. Eligibility criteria were defined using a PICOS framework.

Results: Our study included three articles presenting 342 patient cases. Findings revealed that low-dose corticosteroids combined with the leflunomide group were effective in relieving urine protein excretion (UPE) [mean difference (MD) = -0.35, 95% confidence interval (CI): -0.41 to -0.30, P < 0.00001] compared with the full-dose corticosteroids group. Regarding serum creatinine (SCr), estimated glomerular filtration rate (eGFR), complete remission rate, and overall response rate, there was no difference between the groups (p > 0.05). Regarding safety, low-dose corticosteroids combined with leflunomide significantly reduced the risk of serious adverse events [odds ratio (OR): 0.11, 95% CI: 0.01 to 0.91, P = 0.04]. Besides, no significant differences were observed between the two groups in the incidence of respiratory infection, abnormal liver function, diarrhea, herpes zoster, alopecia, pruritus, insomnia, pneumonia, diabetes, and urinary tract infection (P > 0.05).

Conclusions: Low-dose corticosteroids combined with leflunomide are a safe and effective treatment for progressive IgA nephropathy.

Trial Registration: The PROSPERO registration number is CRD42022361883.

Citing Articles

Contemporary review of IgA nephropathy.

Filippone E, Gulati R, Farber J Front Immunol. 2024; 15:1436923.

PMID: 39188719 PMC: 11345586. DOI: 10.3389/fimmu.2024.1436923.

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