Meta-analysis:antiviral And Immunosuppressive Therapy For Hepatitis B Virus-associated Glomerulonephritis

Objective: Hepatitis B virus-associated nephritis (HBV-GN ) is one of the most common secondary glomerular diseases. Up to now, because its pathogenesis is still not clear enough, we have to use the empirical therapy and the optimal therapy is undefined. The aim of this study was to evaluate the efficacy of drug therapy for HBV-GN objectively by a meta-analysis method and to provid a piece of EBM evidence for clinical therapy.Methods: Medical databases including Medline, EMBASE, OVID, Springlink, CNKI, CBMdisc and VIP were searched in two languages (both English and Chinese) to collected the relative literatures. According to the eligibility and exclusion criteria, we identified literatures strictly, and assessed the quality and publication bias. Then we extracted data. Heterogeneity and sensitivity were examined by Chi-square test through the software Rev Man 4.2. The fixed effect model or random effect model were used to pool the data and performing the subgroup analysis. The results were described by Risk Ratio (RR) and its 95%CI. In addition, other unavailable data were described by words.Results: According to the eligibility and exclusion criteria, eight studies (6 in English, 2 in Chinese) were included. one of them was randomized controlled trial (RCT), and others were cohort studies. 6 studies were included in the group that assessed the efficacy of antiviral therapy (1 RCT, 5 cohort studies). Three of them were about interferon-α, two about lamivudine and one about entecavir.The control group received symptomatic and supportive therapy. There were totally 221 patients included (treatment group 113, control group 108). The meta-analysis showed that, compared with the control group, antiviral therapy could significantly elevate the remission rate of proteinuria (88.5% vs 57.4% , RR = 1.56, 95%CI : 1.10– 2.20, P = 0.01). The sensitivity analysis showed that the result was stable. The virological responses analysis showed that antiviral therapy also could significantly elevate the clearance rate of HBeAg (59.1% vs 17.3% , RR = 3.14, 95%CI: 2.04– 4.83, P < 0.00001), compared with the control group. The sensitivity analysis showed that the result was stable. The result of adults subgroup and children subgroup analysis agreed with the result above-mentioned. On the other hand, 4 studies were included in the group that assessed the efficacy of immunosuppressive theapy. All of them were cohort studies. Two of them were about prednisolone, one about prednisone and one about prednisolone combined with endoxan.The control group received symptomatic and supportive therapy. Meta-analysis showed there was no significant difference between immunosuppressive therapy group and control group in the remission rate of proteinuria (RR = 1.14, 95%CI : 0.59– 2.17, P = 0.70). The result of children subgroup analysis agreed with the result above-mentioned.Conclusions: This study showed the efficacy of antiviral therapy ( including IFN and nucleoside analogues) in HBV-GN. The efficacy was obvious in remission of proteinuria, inhibition of HBV replication, clearance of HBeAg. Most patients performed good tolerance, and no serious adverse effect. But IFN will take heavy economic burden to the patients in long-term therapy, and depress their compliance. Immunosuppressive therapy didn't show any advantage compared with control group, however, the patients likely to have more infection chance.