PMID- 35959430
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220813
IS  - 1663-9812 (Print)
IS  - 1663-9812 (Electronic)
IS  - 1663-9812 (Linking)
VI  - 13
DP  - 2022
TI  - Efficacy and safety of 12 immunosuppressive agents for idiopathic membranous 
      nephropathy in adults: A pairwise and network meta-analysis.
PG  - 917532
LID - 10.3389/fphar.2022.917532 [doi]
LID - 917532
AB  - Background: Immunosuppressants have been applied in the remedy of idiopathic 
      membranous nephropathy (IMN) extensively. Nevertheless, the efficacy and safety 
      of immunosuppressants do not have final conclusion. Thus, a pairwise and network 
      meta-analysis (NMA) was carried out to seek the most recommended therapeutic 
      schedule for patients with IMN. Methods: Randomized controlled trials (RCTs) 
      including cyclophosphamide (CTX), mycophenolate mofetil (MMF), 
      tacrolimus-combined mycophenolate mofetil (TAC + MMF), cyclosporine (CsA), 
      tacrolimus (TAC), leflunomide (LEF), chlorambucil (CH), azathioprine (AZA), 
      adrenocorticotropic hormone (ACTH), non-immunosuppressive therapies (CON), 
      steroids (STE), mizoribine (MZB), and rituximab (RIT) for patients with IMN were 
      checked. Risk ratios (RRs) and standard mean difference (SMD) were reckoned to 
      assess dichotomous variable quantities and continuous variable quantities, 
      respectively. Total remission (TR) and 24-h urine total protein (24-h UTP) were 
      compared using pairwise and NMA. Then interventions were ranked on the basis of 
      the surface under the cumulative ranking curve (SUCRA). Results: Our study 
      finally included 51 RCTs and 12 different immunosuppressants. Compared with the 
      CON group, most regimens demonstrated better therapeutic effect in TR, with RR of 
      2.1 (95% CI) (1.5-2.9) for TAC, 1.9 (1.3-2.8) for RIT, 2.5 (1.2-5.2) for TAC + 
      MMF, 1.9 (1.4-2.7) for CH, 1.8 (1.4-2.4) for CTX, 2.2 (1.0-4.7) for ACTH, 1.6 
      (1.2-2.1) for CsA, 1.6 (1.0-2.5) for LEF, and 1.6 (1.1-2.2) for MMF. In terms of 
      24-h UTP, TAC (SMD, -2.3 (95% CI -3.5 to -1.1)), CTX (SMD, -1.7 (95% CI -2.8 to 
      -0.59)), RIT (SMD, -1.8 (95% CI -3.5 to -0.11)), CH (SMD, -2.4 (95% CI -4.3 to 
      -0.49)), AZA (SMD, --4.2 (95% CI -7.7 to -0.68)), and CsA (SMD, -1.7 (95% CI -3 
      to -0.49)) were significantly superior than the CON group. As for adverse effects 
      (AEs), infections, nausea, emesia, myelosuppression, and glucose intolerance were 
      the collective adverse events for most immunosuppressants. Conclusion: This study 
      indicates that TAC + MMF performed the best in terms of TR, and TAC shows the 
      best effectiveness on 24-h UTP compared with other regimens. On the contrary, 
      there seems to be little advantage on STE alone, LEF, AZA, and MZB in treating 
      patients with IMN compared with CON. Systematic Review Registration: 
      [https://www.crd.york.ac.uk/prospero/], identifier [CRD42021287013].
CI  - Copyright (c) 2022 Liu, Li, Huang and Xu.
FAU - Liu, Jiarong
AU  - Liu J
AD  - Department of Nephrology, The Second Affiliated Hospital of Nanchang University, 
      Nanchang, China.
FAU - Li, Xiang
AU  - Li X
AD  - Department of Nephrology, The Second Affiliated Hospital of Nanchang University, 
      Nanchang, China.
FAU - Huang, Tianlun
AU  - Huang T
AD  - Department of Nephrology, The Second Affiliated Hospital of Nanchang University, 
      Nanchang, China.
FAU - Xu, Gaosi
AU  - Xu G
AD  - Department of Nephrology, The Second Affiliated Hospital of Nanchang University, 
      Nanchang, China.
LA  - eng
PT  - Systematic Review
DEP - 20220725
PL  - Switzerland
TA  - Front Pharmacol
JT  - Frontiers in pharmacology
JID - 101548923
PMC - PMC9358043
OTO - NOTNLM
OT  - adverse effects
OT  - idiopathic membranous nephropathy
OT  - immunosuppressant
OT  - network meta-analysis
OT  - therapies
COIS- The authors declare that the research was conducted in the absence of any 
      commercial or financial relationships that could be construed as a potential 
      conflict of interest.
EDAT- 2022/08/13 06:00
MHDA- 2022/08/13 06:01
PMCR- 2022/07/25
CRDT- 2022/08/12 03:13
PHST- 2022/04/11 00:00 [received]
PHST- 2022/06/27 00:00 [accepted]
PHST- 2022/08/12 03:13 [entrez]
PHST- 2022/08/13 06:00 [pubmed]
PHST- 2022/08/13 06:01 [medline]
PHST- 2022/07/25 00:00 [pmc-release]
AID - 917532 [pii]
AID - 10.3389/fphar.2022.917532 [doi]
PST - epublish
SO  - Front Pharmacol. 2022 Jul 25;13:917532. doi: 10.3389/fphar.2022.917532. 
      eCollection 2022.