Effectiveness and Safety of Mycophenolate Mofetil for IgA Nephropathy: A Meta-Analysis_Chinese Journal of Evidence-Based Medicine

Authors：

YANG Qi , DING Hong ,  WANG Zongqian

Department of Nephrology, The Fourth Affiliated Hospital of China Medical University, Shenyang 110032, China;

Corresponding author：

WANG Zongqian, Email: wangzongqian_sy@163.com

Keywords：

Mycophenolate mofetil; IgA nephropathy; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20120211

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective 　To systematically evaluate the effectiveness and safety of mycophenolate mofetil (MMF) for IgA Nephropathy (IgAN).
Methods 　Databases including CNKI, CBM, MEDLINE, PubMed, The Cochrane Library and SCI were searched from January 1997 to January 2012, and the domestic conference data and relevant published articles were also searched manually. All randomized controlled trials (RCTs) on MMF in treating IgAN were independently collected and screened according to the inclusion and exclusion criteria by two reviewers. The data were extracted, the quality of the included studies was assessed and cross-checked, and then meta-analysis was conducted using RevMan 5.0 software.
Results 　A total of 8 RCTs involving 272 patients with IgAN were included. The results of meta-analyses showed that: a) There were no significant differences in the overall effective rate (RR=0.72, 95%CI 0.21 to 2.52, P=0.61) between the MMF group and the placebo group, but the overall effective rate was higher in the MMF+hormone group than the CTX+hormone group (RR=4.21, 95%CI 1.86 to 9.53, P lt;0.000 1) and other immunosuppressants +hormone groups (RR=3.03, 95%CI 1.47 to 6.25, P=0.003); and b) Adverse reaction: The overall incidence rate of adverse reaction in the MMF+hormone group was lower than the CTX+hormone group (RR=0.16, 95%CI 0.07 to 0.37, P lt;0.000 1). There were no significant differences in the elevated serum creatinine rate (RR=2.28, 95%CI 0.65 to 7.94, P=0.20) and the case number of developing end-stage renal disease (ESRD) (RR=2.37, 95%CI 0.44 to 12.83, P=0.32) between the MMF group and the control group.
Conclusion 　MMF combined with hormone in treating IgAN can increase the overall effective rate and decrease the overall incidence rate of adverse reaction, but its effectiveness of improving long-term survival rate has to be further proved by conducting more high-quality, multi-center and large-scale clinical trials. MMF alone has the same effect as the placebo dose, and it shows no differences in elevated serum creatinine after the treatment compared with conventional therapies.

Citation： YANG Qi,DING Hong,WANG Zongqian. Effectiveness and Safety of Mycophenolate Mofetil for IgA Nephropathy: A Meta-Analysis. Chinese Journal of Evidence-Based Medicine, 2012, 12(11): 1354-1360. doi: 10.7507/1672-2531.20120211 Copy

1.	Srippoli G, Maione A, Tognoni G, et al. IgA Nephropathy:A Disease in Search of a Large-Scale Clinical Trial to Reliably Inform Practice. Am J Kidney Dis, 2009, 53(1): 5-8.
2.	J adad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials, 1996, 17(1): 1-12.
3.	陈香美, 陈仆, 蔡广研, 等. 霉酚酸酯治疗IgA肾病疗效观察. 中华医学杂志, 2002, 82(12): 796-801.
4.	Maes BD, Oyen R, Claes K, et al. Mycophenolate mofetil in IgA nephropathy:results of a 3-year prospective placebo-controlled randomized study. Kidney Int, 2004, 65(5): 1842-1849.
5.	Frisch G, Lin J, Rosenstock J, et al. Mycophenolate mofetil(MMF) vs placebo in patiens with moderately advanced IgA nephropathy:a double-blind randomized controlled trial. Nephrol Dial Transplant, 2005, 20: 2139-2145.
6.	赵瑞英, 刘良田, 梦雅平. 骁悉治疗中重型IgA肾病. 内蒙古医学杂志, 2005, 37(11): 1016-1017.
7.	鲍浩, 唐政, 余雨生, 等. 霉酚酸酯与环磷酰胺治疗新月体型IgA肾病的疗效比较. 2007, 16(5): 401-405, 413.
8.	刘晓渭, 王汉民, 陈威, 等. 来氟米特与霉酚酸酯治疗表现为肾病综合征的IgA肾病的疗效比较. 实用医学杂志, 2007, 23(9): 1378-1379.
9.	刘晓渭, 许国双, 王汉民, 等. 霉酚酸酯与环磷酰胺治疗重症IgA肾病的疗效比较. 西南国防医药, 2007, 17(3): 289-291.
10.	苏清涛. 霉酚酸酯与环磷酰胺治疗重症IgA肾病的临床对照. 中国民族民间医药, 2009, 18(9): 101-103.
11.	席春生, 刘丽, 钟建庭. 霉酚酸酯治疗IgA肾病的Meta分析. 临床内科杂志, 2006, 23(10): 707-709.
12.	傅君, 杨莉雅, 陈俊峰, 等. 霉酚酸酯治疗IgA肾病疗效研究的Meta分析. 东南大学学报(医学版), 2011, 30(6): 849-854.
13.	Tan CH R, Loh PT, Yang WS, et al. Mycophenolate mofetil in the treatment of IgA nephropathy:a systematic review. Singapore Med J, 2008, 49(10): 780-785.
14.	史伟, 主编. IgA肾病. 第1版. 北京: 人民卫生出版社, 2009.
15.	樊均明, 主编. 临床循证医学治疗手册-肾脏疾病. 第1版. 北京: 人民卫生出版社, 2008.

1. Srippoli G, Maione A, Tognoni G, et al. IgA Nephropathy:A Disease in Search of a Large-Scale Clinical Trial to Reliably Inform Practice. Am J Kidney Dis, 2009, 53(1): 5-8.
2. J adad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials, 1996, 17(1): 1-12.
3. 陈香美, 陈仆, 蔡广研, 等. 霉酚酸酯治疗IgA肾病疗效观察. 中华医学杂志, 2002, 82(12): 796-801.
4. Maes BD, Oyen R, Claes K, et al. Mycophenolate mofetil in IgA nephropathy:results of a 3-year prospective placebo-controlled randomized study. Kidney Int, 2004, 65(5): 1842-1849.
5. Frisch G, Lin J, Rosenstock J, et al. Mycophenolate mofetil(MMF) vs placebo in patiens with moderately advanced IgA nephropathy:a double-blind randomized controlled trial. Nephrol Dial Transplant, 2005, 20: 2139-2145.
6. 赵瑞英, 刘良田, 梦雅平. 骁悉治疗中重型IgA肾病. 内蒙古医学杂志, 2005, 37(11): 1016-1017.
7. 鲍浩, 唐政, 余雨生, 等. 霉酚酸酯与环磷酰胺治疗新月体型IgA肾病的疗效比较. 2007, 16(5): 401-405, 413.
8. 刘晓渭, 王汉民, 陈威, 等. 来氟米特与霉酚酸酯治疗表现为肾病综合征的IgA肾病的疗效比较. 实用医学杂志, 2007, 23(9): 1378-1379.
9. 刘晓渭, 许国双, 王汉民, 等. 霉酚酸酯与环磷酰胺治疗重症IgA肾病的疗效比较. 西南国防医药, 2007, 17(3): 289-291.
10. 苏清涛. 霉酚酸酯与环磷酰胺治疗重症IgA肾病的临床对照. 中国民族民间医药, 2009, 18(9): 101-103.
11. 席春生, 刘丽, 钟建庭. 霉酚酸酯治疗IgA肾病的Meta分析. 临床内科杂志, 2006, 23(10): 707-709.
12. 傅君, 杨莉雅, 陈俊峰, 等. 霉酚酸酯治疗IgA肾病疗效研究的Meta分析. 东南大学学报(医学版), 2011, 30(6): 849-854.
13. Tan CH R, Loh PT, Yang WS, et al. Mycophenolate mofetil in the treatment of IgA nephropathy:a systematic review. Singapore Med J, 2008, 49(10): 780-785.
14. 史伟, 主编. IgA肾病. 第1版. 北京: 人民卫生出版社, 2009.
15. 樊均明, 主编. 临床循证医学治疗手册-肾脏疾病. 第1版. 北京: 人民卫生出版社, 2008.

Chinese Journal of Evidence-Based Medicine

Effectiveness and Safety of Mycophenolate Mofetil for IgA Nephropathy: A Meta-Analysis

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content