Long-term effects of immunosuppression treatment on IgA nephropathy: a systematic review and meta-analysis

Abstract

BACKGROUND: Immunoglobulin A (IgA) nephropathy is an immune complex-mediated glomerulonephritis; however, the role of immunosuppression is still controversial, and there is a lack of studies on the long-term efficacy of immunosuppressive drugs in the treatment of the disease. We conducted a meta-analysis to examine the long-term effects of immunosuppressive drugs. METHODS: To identify random control trial articles on immunosuppressive drugs in the treatment of IgA nephropathy with a follow-up time >3 years, the following databases were searched: MEDLINE (1946 to August 2021), EMBASE (2000 to August 2021), PubMed (2000 to August 2021), and Cochrane library (2000 to August 2021). After screening, the Cochrane Handbook of Systematic Reviews of Interventions was used to examine the bias of the studies, Stata16.0 software was used for the analysis, and forest plots were used to present the results. RESULTS: A total of 744 patients from 7 studies were included in the study. The results of the meta-analysis showed that the long-term renal function integrity rate in the experimental group treated with immunosuppressive drugs was higher than that in the control group treated with placebos [risk ratio (RR) =1.10, 95% confidence interval (CI): 1.00, 1.22, Z=1.978, P=0.048], the efficacy of immunosuppressive drugs during the 3-6-year follow-up period (RR =1.07, 95% CI: 0.92, 1.23, Z=0.864, P=0.388) was similar to that of immunosuppressive drugs during the 8-10-year follow-up period (RR =1.14, 95% CI: 1.00, 1.30, Z=1.909, P=0.056), the efficacy of immunosuppressive drug therapy alone (RR =1.11, 95% CI: 1.00, 1.24, Z=1.914, P=0.056) was similar to that of immunosuppressive combination drug therapy (RR =1.07, 95% CI: 0.84, 1.35, Z=0.549, P=0.583), and the adverse reactions in the immunosuppressive drug group were higher than those in the placebo group (RR =1.59, 95% CI: 1.38, 1.85, Z=6.230, P=0.000). DISCUSSION: The use of immunosuppressive drugs can improve the long-term effects of IgA nephropathy treatment, but consideration should be given to the increase of adverse reactions during treatment.