Meta-analysis: anti-viral therapy of hepatitis B virus-associated glomerulonephritis.
BACKGROUND
Hepatitis B virus-associated glomerulonephritis is an infrequent complication of chronic hepatitis B virus (HBV) with significant morbidity. A causal association between hepatitis B virus infection and the development of glomerulonephritis remains controversial. Also, the optimal therapy is undefined although several approaches have been made.


OBJECTIVE
To evaluate the efficacy and safety of anti-viral therapy (interferon or lamivudine) in HBV-associated glomerulonephritis by a systematic review and meta-analysis of clinical trials.


METHODS
The primary outcome was clinical response (as a measure of efficacy); the secondary outcomes were drop-out rate (as a measure of tolerability), and virological response. We used the random effects model of DerSimonian and Laird, with heterogeneity, sensitivity and meta-regression analyses.


RESULTS
We identified six clinical trials (84 unique patients); three had controlled design. The overall estimate for proteinuria remission was 65.2% (95% confidence intervals: 52.7-75.9%), Q-test for heterogeneity = 7.731, P = 0.172, I(2) = 35.327. The overall estimate for hepatitis B e antigen clearance was 62.0% (95% confidence intervals: 50.5-72.2%). The overall estimate for drop-out rate was 12.7% (95% confidence intervals: 6.4-23.6%). Meta-regression analysis showed a significant link between hepatitis B e antigen clearance and logit rate of proteinuria remission after interferon therapy [coefficient -2.585 (S.E. 1.089), P = 0.017].


CONCLUSIONS
Remission of the nephrotic syndrome is accompanied by clearance of HBV replication, supporting the role of the virus in the pathogenesis of the disease.
Fabrizi
F
F
Division of Nephrology, Maggiore Hospital, IRCCS, Milan, Italy. fabrizi@policlinico.mi.it
Dixit
V
V
Martin
P
P
D019380:Anti-HIV Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D005260:Female; D005921:Glomerulonephritis / Q000188:drug therapy* / Q000821:virology; D006511:Hepatitis B Antigens / Q000032:analysis; D019694:Hepatitis B, Chronic / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D007372:Interferons / Q000627:therapeutic use*; D019259:Lamivudine / Q000627:therapeutic use*; D008297:Male; D009404:Nephrotic Syndrome / Q000188:drug therapy / Q000821:virology; D010352:Patient Dropouts; D016896:Treatment Outcome
D019380:Anti-HIV Agents; D000998:Antiviral Agents; D006511:Hepatitis B Antigens; D019259:Lamivudine; D007372:Interferons