title: Immunosuppressive treatment for nephrotic idiopathic membranous nephropathy: a meta-analysis based on Chinese adults.
abstract: BACKGROUND
  Idiopathic membranous nephropathy (IMN) is the most common pathological type for nephrotic syndrome in adults in western countries and China. The benefits and harms of immunosuppressive treatment in IMN remain controversial.
  
  
  OBJECTIVE
  To assess the efficacy and safety of different immunosuppressive agents in the treatment of nephrotic syndrome caused by IMN.
  
  
  METHODS
  PubMed, EMBASE, Cochrane Library and wanfang, weipu, qinghuatongfang, were searched for relevant studies published before December 2011. Reference lists of nephrology textbooks, review articles were checked. A meta-analysis of randomized controlled trials (RCTs) meeting the criteria was performed using Review Manager.
  
  
  RESULTS
  17 studies were included, involving 696 patients. Calcineurin inhibitors had a better effect when compared to alkylating agents, on complete remission (RR 1.61, 95% CI 1.13, to 2.30 P = 0.008), partial or complete remission (effective) (CR/PR, RR 1.29, 95% CI 1.09 to 1.52 P = 0.003), and fewer side effects. Among calcineurin inhibitors, tacrolimus (TAC) was shown statistical significance in inducing more remissions. When compared to cyclophosphamide (CTX), leflunomide (LET) showed no beneficial effect, mycophenolate mofetil (MMF) showed significant beneficial on effectiveness (CR/PR, RR: 1.41, 95% CI 1.16 to 1.72 P = 0.0006) but not significant on complete remission (CR, RR: 1.38, 95% CI 0.89 to 2.13 P = 0.15).
  
  
  CONCLUSIONS
  This analysis based on Chinese adults and short duration RCTs suggested calcineurin inhibitors, especially TAC, were more effective in proteinuria reduction in IMN with acceptable side effects. Long duration RCTs were needed to confirm the long-term effects of those agents in nephrotic IMN.
authors.affiliation: Kidney Institute of CPLA, Division of Nephrology, Changzheng Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Guoqiang
authors.initials: G
authors.lastname: Xie
authors.forename: Jing
authors.initials: J
authors.lastname: Xu
authors.forename: Chaoyang
authors.initials: C
authors.lastname: Ye
authors.forename: Dongping
authors.initials: D
authors.lastname: Chen
authors.forename: Chenggang
authors.initials: C
authors.lastname: Xu
authors.forename: Li
authors.initials: L
authors.lastname: Yang
authors.forename: Yiyi
authors.initials: Y
authors.lastname: Ma
authors.forename: Xiaohong
authors.initials: X
authors.lastname: Hu
authors.forename: Lin
authors.initials: L
authors.lastname: Li
authors.forename: Lijun
authors.initials: L
authors.lastname: Sun
authors.forename: Xuezhi
authors.initials: X
authors.lastname: Zhao
authors.forename: Zhiguo
authors.initials: Z
authors.lastname: Mao
authors.forename: Changlin
authors.initials: C
authors.lastname: Mei
mesh_terms: D000328:Adult; D000477:Alkylating Agents / Q000494:pharmacology; D065095:Calcineurin Inhibitors; D002681:China; D002699:Chlorambucil / Q000494:pharmacology; D002986:Clinical Trials as Topic; D003520:Cyclophosphamide / Q000494:pharmacology; D016572:Cyclosporine / Q000494:pharmacology; D005260:Female; D015433:Glomerulonephritis, Membranous / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007555:Isoxazoles / Q000494:pharmacology; D000077339:Leflunomide; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000494:pharmacology; D012074:Remission Induction; D016559:Tacrolimus / Q000494:pharmacology
chemical_list: D000477:Alkylating Agents; D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D007555:Isoxazoles; D002699:Chlorambucil; D016572:Cyclosporine; D003520:Cyclophosphamide; D000077339:Leflunomide; D009173:Mycophenolic Acid; D016559:Tacrolimus