Summary
The efficacy and safety of tacrolimus (TAC) and cyclophosphamide (CTX) in the treatment of idiopathic membranous nephropathy (IMN) were compared in Chinese adult patients using a meta- analysis of the available literatures. Randomized controlled clinical trials (RCTs) of the treatment of primary IMN with TAC or CTX combined with corticosteroids in the English databases PubMed, Embase and Cochrane, as well as Chinese databases, were searched. Qualified studies were subjected to quality assessment and meta-analysis. A total of 8 RCTs, including 359 Chinese patients, were included in the meta-analysis. The complete remission rate and overall remission rate in the TAC treatment group after 6 months of treatment were higher than those in the CTX treatment group. No significant difference in remission rate was found after 12 months of treatment. There was no significant difference in the adverse reaction between the two groups at the 6th or 12th months. TAC-based treatment was associated with a faster response than CTX at the 6th month, but there was no significant difference between the two groups at 12th month in Chinese adults. Further study is needed to evaluate the long-term efficacy and safety of this treatment regimen.
Similar content being viewed by others
References
Beck LH Jr, Bonegio RG, Lambeau G, et al. M-type phospholipase a2 receptor as target antigen in idiopathic membranous nephropathy. N Engl J Med, 2009,361(1):11–21
Stanescu HC, Arcos-Burgos M, Medlar A, et al. Risk hla-dqa1 and pla(2)r1 alleles in idiopathic membranous nephropathy. N Engl J Med, 2011,364(7):616–626
Bullich G, Ballarin J, Oliver A, et al. HLA-DQA1 and PLA2R1 polymorphisms and risk of idiopathic membranous nephropathy. Clin J Am Soc Nephrol, 2014,9(2): 335–343
Liu YH, Chen CH, Chen SY, et al. Association of phospholipase a2 receptor 1 polymorphisms with idiopathic membranous nephropathy in Chinese patients in Taiwan. J Biomed Sci, 2010,17(1):81
Kim S, Chin HJ, Na KY, et al. Single nucleotide polymorphisms in the phospholipase a2 receptor gene are associated with genetic susceptibility to idiopathic membranous nephropathy. Nephron Clin Pract, 2011,117(3):c253–258
Coenen MJ, Hofstra JM, Debiec H, et al. Phospholipase a2 receptor (pla2r1) sequence variants in idiopathic membranous nephropathy. J Am Soc Nephrol, 2013,24(4): 677–683
Ponticelli C, Glassock RJ. Glomerular diseases: Membranous nephropathy—a modern view. Clin J Am Soc Nephrol, 2013,9(3):609–616
Xu J, Zhang W, Xu Y, et al. Tacrolimus combined with corticosteroids in idiopathic membranous nephropathy: A randomized, prospective, controlled trial. Contrib Nephrol, 2013,181:152–162
Li X, Lv R, He Q, et al. Early initiation of tacrolimus or cyclophosphamide therapy for idiopathic membranous nephropathy with severe proteinuria. J Nephrol, 2008,21(4):584–591
Chen W, Chen D, Xu G. An observation of tacrolimus in the treatment of idiopathic membranous nephropathy. Shiyong Yixue Zazhi (Chinese), 2009,25(10):1674–1675
Li Y, Wang S, Zhao J, et al. Comparison of the efficacies of tacrolimus and cyclophosphamide combined with hormone in the treatment of idiopathic membranous nephropathy. Zhongguo Linchuang Yaolixue Yu Zhiliaoxue (Chinese), 2012,17(7): 797–801
Liu J. The study on the treatment of idiopathic membranous nephropathy with tacrolimus. Graduation dissertation, 2009
Chen M, Li H, Li XY, et al. Tacrolimus combined with corticosteroids in treatment of nephrotic idiopathic membranous nephropathy: A multicenter randomized controlled trial. Am J Med Sci, 2010,339(3):233–238
Shen X. Clinical observation of tacrolimus in combination with low-dose glucocorticoid in treating idiopathic membranous nephropathy. Graduation dissertation, 2012
He L, Peng Y, Liu H, et al. Treatment of idiopathic membranous nephropathy with combination of low-dose tacrolimus and corticosteroids. J Nephrol, 2013,26(3):564–571
Yuan H, Liu N, Sun GD, et al. Effect of prolonged tacrolimus treatment in idiopathic membranous nephropathy with nephrotic syndrome. Pharmacology, 2013,91(5–6): 259–266
Xie G, Xu J, Ye C, et al. Immunosuppressive treatment for nephrotic idiopathic membranous nephropathy: A meta-analysis based on chinese adults. PLoS One, 2012,7(9): e44330
Author information
Authors and Affiliations
Corresponding author
Additional information
This project was supported by the National Natural Science Foundation of China (No. 30800523 and 81570657), and a grant from Hubei Province Health and Family Planning Commission (No. WJ2015MB013).
Rights and permissions
About this article
Cite this article
Li, Zq., Hu, Ml., Zhang, C. et al. Efficacy and safety of tacrolimus vs. cyclophosphamide for idiopathic membranous nephropathy: A meta-analysis of Chinese adults. J. Huazhong Univ. Sci. Technol. [Med. Sci.] 35, 623–628 (2015). https://doi.org/10.1007/s11596-015-1480-8
Received:
Revised:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11596-015-1480-8