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The efficacy and safety of immunosuppressive agents plus steroids compared with steroids alone in the treatment of Henoch–Schönlein purpura nephritis: A meta-analysis

  • Jiaxing Tan
  • Yi Tang
  • Zhengxia Zhong
  • Siyu Yan
  • Li Tan
  • Padamata Tarun
  • Wei QinEmail author
Nephrology-Review
  • 20 Downloads

Abstract

Background

Henoch–Schönlein purpura nephritis (HSPN) is the most severe symptom of Henoch–Schönlein purpura. The role of immunosuppressive agents combined with steroids is controversial in treating HSPN. Our meta-analysis was performed to assess the efficacy and safety of the combined therapy in the treatment of HSPN compared with steroids alone.

Methods

Cochrane Library, Pubmed, Embase, and Web of Science were searched and Newcastle–Ottawa Scale was used to assess the quality of the literatures. Odds ratios (OR) and standard mean difference (SMD) with a 95% confidence interval (CI) were used for dichotomous and continuous variables. A random-effect model or fixed-effect analysis was applied according to heterogeneity.

Results

A total of 9 articles were selected in our study. HSPN patients treated with combined therapy demonstrated a significant increase in complete remission rates (OR = 1.95; 95% CI 1.17–3.23, P = 0.010) and total remission rates (OR = 2.30 95% CI 1.33–3.98, P = 0.003) when compared with steroids alone. Children seemed to benefit more from combined treatment (OR = 2.45; CI 1.20–5.02, P = 0.014) than adults (OR = 1.56; CI 0.76–3.20, P = 0.225). Additionally, immunosuppressants plus steroids had an advantage on decreasing proteinuria (SMD = 0.28; CI 0.05–0.52, P = 0.019) and increasing the level of serum albumin (SMD = 0.98; CI 0.35–1.60, P = 0.002). However, significant differences were not found in the estimated glomerular filtration rate (eGFR) and rates of side-effects.

Conclusion

Administration of immunosuppressive agents combined with steroids may be a superior alternative for HSPN. Nevertheless, long-term, high-quality, large-sample, and multicenter RCTs are required to make the results more convincing.

Keywords

Henoch–Schönlein purpura nephritis HSPN Immunosuppressive agents Steroids Meta-analysis 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare no conflict of interest in this manuscript.

Research involving human and animal participants

This article does not contain any studies with human participants performed by any of the authors.

Supplementary material

11255_2019_2092_MOESM1_ESM.pdf (92 kb)
Supplementary material 1 (PDF 92 KB)
11255_2019_2092_MOESM2_ESM.docx (16 kb)
Supplementary material 2 (DOCX 16 KB)

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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Division of Nephrology, Department of Medicine, West China HospitalSichuan UniversityChengduChina
  2. 2.West China School of MedicineSichuan UniversityChengduChina

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