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Efficacy and safety of glucocorticoids for patients with IgA nephropathy: a meta-analysis

  • Nephrology - Review
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Abstract

Background

The efficacy and safety of glucocorticoids for the treatment of patients with IgA nephropathy (IgAN) remains controversial. The aim of the study is to perform a metaanalysis of randomized controlled trials to evaluate the efficacy and safety of glucocorticoids for patients with IgAN.

Methods

We searched PubMed, EMBASE and the Cochrane Library and article reference lists of Controlled Trials, and Clinical Trial Registries for randomized controlled trials comparing glucocorticoids with other non-immunosuppressive agents in patients with IgAN.

Results

The present meta-analysis, including 10 RCTs and 791 patients from 12 published studies, showed that using glucocorticoids agents relatively preserves kidney function(RR 0.06, 95% CI 0.14–0.61) and plays an effective role on reducing the proteinuria(SMD, − 0.69; 95% CI 0.85 to − 0.53, p < 0.00001; heterogeneity I2 = 0%; p = 0.09) compared with a control group. Moreover, adverse events cannot be neglected, especially gastrointestinal tract (RR 3.10, 95% CI 1.37–6.98, p = 0.006; heterogeneity I2 = 0%, p = 0.86), and corticosteroid regimens in IgAN should be reviewed with regard to safety.

Conclusions

Glucocorticoids were wildly used to treat various diseases including IgAN. Meanwhile, adverse events cannot be neglected, such as gastrointestinal adverse events, infection and so on. Corticosteroid should be used with reserve, especially in those patients with hypertension and impaired renal function or older patients.

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Acknowledgements

We thank Christina Croney, PhD, from Liwen Bianji, Edanz Group China (http://www.liwenbianji.cn/ac), for editing a draft of this manuscript.

Funding

This study was supported by grants from the Guangdong Provincial Science and Technology Project (No. 2014A020212662), the Science and Technology Planning Project of Southern Medical University (No. CX2016N018), the Science and Technology Planning Project of Tianhe District, Guangzhou City (No. 201704KW011), The Natural Science Foundation of Guangdong Province (2016A030313559) and The South Wisdom Valley Innovative Research Team Program (2014CXTD04, 2014).

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Authors and Affiliations

  1. Department of Nephrology, Institute of Nephrology and Urology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, 510630, China

    Ge Qian, Weicheng Xu, Hequn Zou & Yongqiang Li

  2. Department of Non-communicable Disease Control and Prevention, Xi’an Municipal Center for Disease Control and Prevention, Xi’an, 710054, China

    Xiaoyu Zhang

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  1. Ge Qian
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  2. Xiaoyu Zhang
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  3. Weicheng Xu
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  4. Hequn Zou
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Contributions

HZ, YL conceived the idea for this systematic review. GQ, XZ and WX developed the methodology for the systematic review, and YL and XZ supervised the methodological process. The manuscript was drafted by GQ and XZ. All authors critically reviewed and approved the final manuscript.

Corresponding author

Correspondence to Yongqiang Li.

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The authors declare that they have no competing interests.

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Ethics approval is not required because this is a protocol for a systematic review and meta-analysis in which no primary human data will be collected.

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Qian, G., Zhang, X., Xu, W. et al. Efficacy and safety of glucocorticoids for patients with IgA nephropathy: a meta-analysis. Int Urol Nephrol 51, 859–868 (2019). https://doi.org/10.1007/s11255-019-02094-5

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  • DOI: https://doi.org/10.1007/s11255-019-02094-5

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