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  • Title: The efficacy and safety of immunosuppressive agents plus steroids compared with steroids alone in the treatment of Henoch-Schönlein purpura nephritis: A meta-analysis.
    Author: Tan J, Tang Y, Zhong Z, Yan S, Tan L, Tarun P, Qin W.
    Journal: Int Urol Nephrol; 2019 Jun; 51(6):975-985. PubMed ID: 30989564.
    Abstract:
    BACKGROUND: Henoch-Schönlein purpura nephritis (HSPN) is the most severe symptom of Henoch-Schönlein purpura. The role of immunosuppressive agents combined with steroids is controversial in treating HSPN. Our meta-analysis was performed to assess the efficacy and safety of the combined therapy in the treatment of HSPN compared with steroids alone. METHODS: Cochrane Library, Pubmed, Embase, and Web of Science were searched and Newcastle-Ottawa Scale was used to assess the quality of the literatures. Odds ratios (OR) and standard mean difference (SMD) with a 95% confidence interval (CI) were used for dichotomous and continuous variables. A random-effect model or fixed-effect analysis was applied according to heterogeneity. RESULTS: A total of 9 articles were selected in our study. HSPN patients treated with combined therapy demonstrated a significant increase in complete remission rates (OR = 1.95; 95% CI 1.17-3.23, P = 0.010) and total remission rates (OR = 2.30 95% CI 1.33-3.98, P = 0.003) when compared with steroids alone. Children seemed to benefit more from combined treatment (OR = 2.45; CI 1.20-5.02, P = 0.014) than adults (OR = 1.56; CI 0.76-3.20, P = 0.225). Additionally, immunosuppressants plus steroids had an advantage on decreasing proteinuria (SMD = 0.28; CI 0.05-0.52, P = 0.019) and increasing the level of serum albumin (SMD = 0.98; CI 0.35-1.60, P = 0.002). However, significant differences were not found in the estimated glomerular filtration rate (eGFR) and rates of side-effects. CONCLUSION: Administration of immunosuppressive agents combined with steroids may be a superior alternative for HSPN. Nevertheless, long-term, high-quality, large-sample, and multicenter RCTs are required to make the results more convincing.
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