title: Meta-analysis of the efficacy and safety of nucleotide/nucleoside analog monotherapy for hepatitis B virus-associated glomerulonephritis.
abstract: OBJECTIVE
  Antiviral monotherapy is recommended for hepatitis B virus-associated glomerulonephritis (HBV-GN) treatment. Although considered superior to interferon-Î± in several respects, nucleotide/nucleoside analog (NA) monotherapy has not been studied. This metaanalysis evaluates the efficacy and safety of NA monotherapy for treating HBV-GN.
  
  
  METHODS
  We searched for controlled clinical trials of NA monotherapy for HBVGN in the MEDLINE, Embase, Cochrane Library, Chinese BioMedical Literature on disc, Chinese National Knowledge Infrastructure, and Wanfang databases. Primary outcome measures were proteinuria remission, HBV-DNA negative conversion rate, and hepatitis B e-antigen (HBeAg) clearance. Secondary outcome measures were variations in proteinuria, serum albumin, alanine aminotransferase (ALT), and serum creatinine (Scr).
  
  
  RESULTS
  Ten trials involving 325 patients were included: four randomized controlled trials, two cohort clinical trials, and four self-controlled studies. Based on the fixed-effects model, we found significant proteinuria remission rate improvement in the NA group (relative risk (RR): 3.60, 95% confidence interval (CI): 1.99 â 6.50), negative conversion rate of HBV-DNA (RR: 2.20, 95% CI: 1.55 â 3.13), and clearance of HBeAg (RR: 4.49, 95% CI: 1.29 â 15.67). Improvement in ALT (mean difference (MD): 56.60, 95% CI: 50.41 â 62.79) was found with the fixedeffects model, and a slight decrease in Scr (MD: 25.25, 95% CI: â17.11 â 67.61, p = 0.24) was shown.
  
  
  CONCLUSIONS
  HBV-GN proteinuria remission with elevated serum albumin, decreased HBV replication, and improved HBeAg clearance could be achieved using NA monotherapy. Furthermore, NA monotherapy may protect renal function in HBV-GN patients by preventing Scr elevation.
authors.forename: Wan-ning
authors.initials: WN
authors.lastname: Wang
authors.forename: Mei-yan
authors.initials: MY
authors.lastname: Wu
authors.forename: Fu-zhe
authors.initials: FZ
authors.lastname: Ma
authors.forename: Tao
authors.initials: T
authors.lastname: Sun
authors.forename: Zhong-gao
authors.initials: ZG
authors.lastname: Xu
mesh_terms: D000410:Alanine Transaminase / Q000097:blood; D000419:Albuminuria / Q000821:virology; D000998:Antiviral Agents / Q000627:therapeutic use; D003404:Creatinine / Q000097:blood; D004279:DNA, Viral / Q000097:blood; D005921:Glomerulonephritis / Q000276:immunology / Q000821:virology; D006513:Hepatitis B e Antigens / Q000097:blood; D006515:Hepatitis B virus; D019694:Hepatitis B, Chronic / Q000097:blood / Q000150:complications / Q000188:drug therapy; D006801:Humans; D009711:Nucleotides; D012709:Serum Albumin / Q000378:metabolism
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D006513:Hepatitis B e Antigens; D009711:Nucleotides; D012709:Serum Albumin; D003404:Creatinine; D000410:Alanine Transaminase