title: The long-term efficacy and safety of immunosuppressive therapy on the progression of IgA nephropathy: a meta-analysis of controlled clinical trials with more than 5-year follow-up.
abstract: OBJECTIVE
  To evaluate the long-term efficacy of immunosuppressive therapy on Immunoglobulin A nephropathy (IgAN).
  
  
  METHODS
  Trials with at least 5-year follow-up investigating immunosuppressive therapy were selected.
  
  
  METHODS
  Primary outcome was end-stage renal disease (ESRD). Secondary outcome was deterioration in renal function defined as doubled serum creatinine or 50% reduction of eGFR.
  
  
  RESULTS
  Seven studies were enrolled. Immunosuppression lowered the risk for ESRD risk ratio (RR = 0.30, 95% CI 0.19 - 0.48, p < 0.00001) and deterioration in renal function (RR = 0.19, 95% CI 0.07 - 0.54, p = 0.002). As for pooled RRs of ESRD, there were four studies with < 7-year follow-up, three followed for > 7 years, four adopted corticosteroids, two used corticosteroids plus other immunosuppressive agents, four were from Asia, and three from Europe. Pooled RRs were 0.32 (95% CI, 0.18 - 0.58, p = 0.0001), 0.28 (95% CI, 0.13 - 0.59, p = 0.0009), 0.34 (95% CI, 0.17 - 0.67, p = 0.002), 0.29 (95% CI, 0.15 - 0.58, p = 0.0005), 0.37 (95% CI, 0.20 - 0.68, p = 0.001) and 0.23 (95% CI, 0.11 - 0.47, p < 0.0001), respectively. Immunosuppression was associated with an increased risk for adverse events (RR = 2.13, 95% CI 1.17 - 3.86, p = 0.01).
  
  
  CONCLUSIONS
  Immunosuppressive therapy for IgAN might reduce long-term risk of ESRD and deterioration in renal function but increase risk of adverse events, and the efficacy on patients from Europe and Asia might be similar. Addition of other immunosuppressive agents did not provide additional benefit.
authors.affiliation: Shanghai Jiao Tong University, Ren Ji Hospital, School of Medicine, Molecular Cell Lab for Kidney Disease, Department of Nephrology , 1630 Dongfang Road, Shanghai , China +86 21 6838 3188 ; +86 21 6838 3124 ; shanmou_renji@126.com.
authors.forename: Lei
authors.initials: L
authors.lastname: Tian
authors.forename: Xinghua
authors.initials: X
authors.lastname: Shao
authors.forename: Yuanyuan
authors.initials: Y
authors.lastname: Xie
authors.forename: Ling
authors.initials: L
authors.lastname: Wang
authors.forename: Qin
authors.initials: Q
authors.lastname: Wang
authors.forename: Xiajing
authors.initials: X
authors.lastname: Che
authors.forename: Zhaohui
authors.initials: Z
authors.lastname: Ni
authors.forename: Shan
authors.initials: S
authors.lastname: Mou
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D018849:Controlled Clinical Trials as Topic; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005500:Follow-Up Studies; D005922:Glomerulonephritis, IGA / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000517:prevention & control
chemical_list: D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents
keywords: end-stage renal disease; immunoglobulin A nephropathy; immunosuppressive therapy; meta-analysis