Efficacy and Safety of Mycophenolate Mofetil for Henoch-Schonlein Purpura Nephritis: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

 XIONGJia-chuan ¹ , TIANMao-lu ¹ , HEZhao-xia ¹ , WUHong-mei ² ,  HUZhang-xue ¹

1. Department of Nephrology, West China Hospital, Sichuan University, Chengdu 610041, China;
2. The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

HUZhang-xue, Email: hzxawy@hotmail.com

Keywords：

Mycophenolate mofetil; Cyclophosphamide; Henoch-Schonlein purpura nephritis; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20140033

Video：

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Objective To systematically review the efficacy and safety of mycophenolate mofetil (MMF) for Henoch-Schonlein purpura nephritis (HSPN). Methods Databases such as PubMed, EMbase, CENTRAL, VIP, CNKI, CBM and WanFang Data were electronically searched for comprehensively collecting the randomized controlled trials (RCTs) on the efficacy and safety of MMF for HSPN from inception to December, 2013. Two reviewers independently screened studies according to the inclusion and exclusion criteria, extracted data and evaluated the methodological quality of the included studies. Then meta-analysis was performed using RevMan 5.1 software. Results A total of 10 RCTs involving 426 patients (231 in the trial group and 195 in the control group) were included. The trial group was treated with MMF and corticosteroids, and the control group was treated with corticosteroids monotherapy or combined with cyclophosphamide (CTX), leflunomide (LEF), or azathioprine (AZA). The results of meta-analysis showed that, as for efficacy, no significant difference was found between the two groups after six-mouth treatment (OR=1.36, 95%CI 0.67 to 2.73, P=0.85), while after twelve-mouth treatment, MMF was superior to CTX with a significant difference (OR=6.58, 95%CI 2.45 to 17.33, P=0.002). In addition, the efficacy of MMF was still superior to the azathioprine group, but not better than either LEF or prednisone monotherapy. Lower incidence of side effects were found in the MMF group, compared with the CTX group (OR=0.25, 95%CI 0.13 to 0.45, P < 0.000 01) and the prednisone monotherapy group (OR=0.26, 95%CI, 0.09 to 0.79, P=0.02), while there was no significant difference between the MMF group and the LEF group in side effects. Conclusion Based on the current evidence, the efficacy of MMF for HSPN is better than CTX, and its side effects are less than those of CTX and prednisone.

Citation： XIONGJia-chuan, TIANMao-lu, HEZhao-xia, WUHong-mei, HUZhang-xue. Efficacy and Safety of Mycophenolate Mofetil for Henoch-Schonlein Purpura Nephritis: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2014, 14(2): 184-190. doi: 10.7507/1672-2531.20140033 Copy

1.	Saulsbury FT. Henoch-Schonlein purpura. Curr Opin Rheumatol, 2001, 13(1):35.
2.	Sinclair P. Henoch-schönlein purpura-a review:review article. Curr Allergy Clin Im, 2010, 23(3):116-120.
3.	Saulsbury FT. Henoch-Schonlein purpura in children:Report of 100 patients and review of the literature. Medicine, 1999, 78(6):395.
4.	Fervenza FC. Henoch-Schönlein purpura nephritis. Int J Dermatol, 2003, 42(3):170-177.
5.	Narchi H. Risk of long term renal impairment and duration of follow up recommended for Henoch-Schönlein purpura with normal or minimal urinary findings:a systematic review. Arch Dis Child, 2005, 90(9):916-920.
6.	Davin J C, Weening J. Henoch-Schönlein purpura nephritis:an update. Eur J Pediatr, 2001, 160(12):689-695.
7.	Jauholo O, Ronkainen J, Koskimies O, et al. Renal manifestations of Henoch-Schönlein purpura in a 6-month prospective study of 223 children. Arch Dis Child, 2010, 95(11):877-882.
8.	Koskimies O, Mir S, Rapola J, et al. Henoch-Schönlein nephritis:long-term prognosis of unselected patients. Arch Dis Child, 1981, 56(6):482-484.
9.	Faedda R, Pirisi M, Satta A, et al. Regression of Henoch-Schönlein disease with intensive immunosuppressive treatment. Clin Pharmacol Ther, 1996, 60(5):576-581.
10.	Deng F, Lu L, Zhang Q, et al. Improved Outcome of HenochSchonlein Purpura Nephritis by Early Intensive Treatment. Indian J Pediatr, 2012, 79(2):207-212.
11.	Peru H, Soylemzoglu O, Bakkaloglu SA, et al. Henoch Schonlein purpura in childhood:clinical analysis of 254 cases over a 3-year period. Clin Rheumatol, 2008, 27(9):1087-1092.
12.	Villarroel M, Hidalgo M, Jimeno A. Mycophenolate mofetil:An update. Drug Today(Barcelona, Spain:1998), 2009, 45(7):521.
13.	van Gelder T, Meur YL, Shaw LM, et al. Therapeutic drug monitoring of mycophenolate mofetil in transplantation. Ther Drug Monit, 2006, 28(2):145.
14.	Kawasaki Y. The pathogenesis and treatment of pediatric HenochSchönlein purpura nephritis. Clin Exp Nephrol, 2011, 15(5):648-657.
15.	Dudley J, Smith G, Llewellyn-Edwards A, et al. Randomised placebo controlled trial to assess the role of early prednisolone on the development and progression of Henoch-Schonlein purpura nephritis. Pediatr Nephrol, 2007, 22(9):1457.
16.	Mills JA, Michel BA, Bloch DA, et al. The American College of Rheumatology 1990 criteria for the classification of Henoch-Schönlein purpura. Arthritis Rheum, 1990, 33(8):1114-1121.
17.	Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5. 1. 0[updated March 2011]. The Cochrane Collaboration, 2011.
18.	Fuentes Y, Valverds S, Velasquez-Jones L, et al. Comparison of azathioprine vs. mofetil mycofenolate for henoch-schonlein nephritis treatment. Pediatr Nephrol, 2010, 25(9):1802.
19.	俞全胜, 朱光华, 何威逊, 等.霉酚酸酯与环磷酰胺治疗肾病综合征型紫癜性肾炎疗效比较.临床儿科杂志, 2007, 25(4):271-273.
20.	孙剑, 张浩, 刘纪实, 等.来氟米特与霉酚酸酯治疗表现为肾病综合征的过敏紫癜性肾炎的疗效比较.中国中西医结合肾病杂志, 2008, 9(8):691-693.
21.	李英, 桂明, 李杨.免疫抑制剂治疗肾病综合征型紫癜肾炎的临床疗效比较.临床医学工程, 2011, 18(3):347-349.
22.	杜悦, 吴玉斌, 李心瑶.霉酚酸酯与环磷酰胺冲击疗法治疗儿童紫癜性肾炎的疗效比较.中国医科大学学报, 2010, 5(3):352-355.
23.	林炯程, 胡伟新, 唐政, 等.霉酚酸酯与环磷酰胺治疗重症过敏紫癜性肾炎的疗效比较.肾脏病与透析肾移植杂志, 2005, 14(6):508-513.
24.	潘月玲.霉酚酸酯联合激素治疗成人紫癜性肾炎的临床研究.中国实用医药, 2010, 33(1):48-49.
25.	王康, 沈彦波, 徐崇松.吗替麦考酚酯联合低分子肝素钙治疗原发性难治性肾病综合征.中国保健, 2008, 16(27):1291-1294.
26.	Ren P, Han F, Chen L, et al. The combination of mycophenolate mofetil with corticosteroids induces remission of Henoch-Schonlein purpura nephritis. Am J Nephrol, 2012;36:271-277.
27.	麦水强, 庞国象, 李有国.霉酚酸酯治疗紫癜性肾炎的临床观察.中国误诊学杂志2009, 9(22):5348-5349.
28.	Kidney Disease:Improving Global Outcomes(KDIGO)Glomerulonephritis Work Group. KDIGO Clinical Practice Guideline for Glomerulonephritis. Kidney Int, Suppl, 2012, 2(2):139-274.

1. Saulsbury FT. Henoch-Schonlein purpura. Curr Opin Rheumatol, 2001, 13(1):35.
2. Sinclair P. Henoch-schönlein purpura-a review:review article. Curr Allergy Clin Im, 2010, 23(3):116-120.
3. Saulsbury FT. Henoch-Schonlein purpura in children:Report of 100 patients and review of the literature. Medicine, 1999, 78(6):395.
4. Fervenza FC. Henoch-Schönlein purpura nephritis. Int J Dermatol, 2003, 42(3):170-177.
5. Narchi H. Risk of long term renal impairment and duration of follow up recommended for Henoch-Schönlein purpura with normal or minimal urinary findings:a systematic review. Arch Dis Child, 2005, 90(9):916-920.
6. Davin J C, Weening J. Henoch-Schönlein purpura nephritis:an update. Eur J Pediatr, 2001, 160(12):689-695.
7. Jauholo O, Ronkainen J, Koskimies O, et al. Renal manifestations of Henoch-Schönlein purpura in a 6-month prospective study of 223 children. Arch Dis Child, 2010, 95(11):877-882.
8. Koskimies O, Mir S, Rapola J, et al. Henoch-Schönlein nephritis:long-term prognosis of unselected patients. Arch Dis Child, 1981, 56(6):482-484.
9. Faedda R, Pirisi M, Satta A, et al. Regression of Henoch-Schönlein disease with intensive immunosuppressive treatment. Clin Pharmacol Ther, 1996, 60(5):576-581.
10. Deng F, Lu L, Zhang Q, et al. Improved Outcome of HenochSchonlein Purpura Nephritis by Early Intensive Treatment. Indian J Pediatr, 2012, 79(2):207-212.
11. Peru H, Soylemzoglu O, Bakkaloglu SA, et al. Henoch Schonlein purpura in childhood:clinical analysis of 254 cases over a 3-year period. Clin Rheumatol, 2008, 27(9):1087-1092.
12. Villarroel M, Hidalgo M, Jimeno A. Mycophenolate mofetil:An update. Drug Today(Barcelona, Spain:1998), 2009, 45(7):521.
13. van Gelder T, Meur YL, Shaw LM, et al. Therapeutic drug monitoring of mycophenolate mofetil in transplantation. Ther Drug Monit, 2006, 28(2):145.
14. Kawasaki Y. The pathogenesis and treatment of pediatric HenochSchönlein purpura nephritis. Clin Exp Nephrol, 2011, 15(5):648-657.
15. Dudley J, Smith G, Llewellyn-Edwards A, et al. Randomised placebo controlled trial to assess the role of early prednisolone on the development and progression of Henoch-Schonlein purpura nephritis. Pediatr Nephrol, 2007, 22(9):1457.
16. Mills JA, Michel BA, Bloch DA, et al. The American College of Rheumatology 1990 criteria for the classification of Henoch-Schönlein purpura. Arthritis Rheum, 1990, 33(8):1114-1121.
17. Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5. 1. 0[updated March 2011]. The Cochrane Collaboration, 2011.
18. Fuentes Y, Valverds S, Velasquez-Jones L, et al. Comparison of azathioprine vs. mofetil mycofenolate for henoch-schonlein nephritis treatment. Pediatr Nephrol, 2010, 25(9):1802.
19. 俞全胜, 朱光华, 何威逊, 等.霉酚酸酯与环磷酰胺治疗肾病综合征型紫癜性肾炎疗效比较.临床儿科杂志, 2007, 25(4):271-273.
20. 孙剑, 张浩, 刘纪实, 等.来氟米特与霉酚酸酯治疗表现为肾病综合征的过敏紫癜性肾炎的疗效比较.中国中西医结合肾病杂志, 2008, 9(8):691-693.
21. 李英, 桂明, 李杨.免疫抑制剂治疗肾病综合征型紫癜肾炎的临床疗效比较.临床医学工程, 2011, 18(3):347-349.
22. 杜悦, 吴玉斌, 李心瑶.霉酚酸酯与环磷酰胺冲击疗法治疗儿童紫癜性肾炎的疗效比较.中国医科大学学报, 2010, 5(3):352-355.
23. 林炯程, 胡伟新, 唐政, 等.霉酚酸酯与环磷酰胺治疗重症过敏紫癜性肾炎的疗效比较.肾脏病与透析肾移植杂志, 2005, 14(6):508-513.
24. 潘月玲.霉酚酸酯联合激素治疗成人紫癜性肾炎的临床研究.中国实用医药, 2010, 33(1):48-49.
25. 王康, 沈彦波, 徐崇松.吗替麦考酚酯联合低分子肝素钙治疗原发性难治性肾病综合征.中国保健, 2008, 16(27):1291-1294.
26. Ren P, Han F, Chen L, et al. The combination of mycophenolate mofetil with corticosteroids induces remission of Henoch-Schonlein purpura nephritis. Am J Nephrol, 2012;36:271-277.
27. 麦水强, 庞国象, 李有国.霉酚酸酯治疗紫癜性肾炎的临床观察.中国误诊学杂志2009, 9(22):5348-5349.
28. Kidney Disease:Improving Global Outcomes(KDIGO)Glomerulonephritis Work Group. KDIGO Clinical Practice Guideline for Glomerulonephritis. Kidney Int, Suppl, 2012, 2(2):139-274.

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Efficacy and Safety of Mycophenolate Mofetil for Henoch-Schonlein Purpura Nephritis: A Systematic Review

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