Comparing Tacrolimus And Cyclophosphamide In The Treatment For Idiopathic Membranous Nephropathy:A Meta-analysis

Objective The purpose of this study was to evaluate the short-term efficacy and safety of tacrolimus and cyclophosphamide in the treatment of idiopathic membranous nephropathy(IMN) by meta-analysis.Methods Publications in the English and Chinese literature were searched with the Keywords“Tacrolimus 、 FK506 、 Membranous nephropathy 、 Idiopathic membranous nephropathy 、 Cyclophosphamide”.Studies addressing the effect of tacrolimus in idiopathic membranous nephropathy were searched on Pub Med,Medline, Cochrane library, China How Net, Wanfang and VIP Chinese scientific and technical journals and other databases(from building a database to January 2015).Trials comparing tacrolimus with corticosteroid versus cyclophosphamide with corticosteroid in the treatment of idiopathic membranous nephropathy were included.The quality of the studies was assessed using Jadad method and statistical analyses were performed using Rev Man5.3 software.Results Ten clinical studies(including eight prospective randomized controlled clinical trials and two cohort studies) of 506 patients were collected.Among the patients,255 were treated with tacrolimus and 251 were treated with cyclophosphamide.Meta-analysis showed that compared with cyclophosphamide group, tacrolimus was more effective in complete remission [RR=1.72(1.32,2.24),P<0.0001] and the total remissions [RR=1.23(1.11,1.37),P=0.0001] at 6 months follow-up and there was no statistical significance in partial remissions [RR=0.94(0.76,1.16),P=0.57].Meanwhile,compared with cyclophosphamide group,tacrolimus group has less adverse effects like infection [RR=0.55(0.36,0.86),P=0.008], impaired liver function[RR=0.49(0.26,0.90), P=0.02], impaired glucose tolerance [RR=1.87(1.04,3.34),P=0.04], gastrointestinal reactions [RR=0.48(0.24,0.96), P = 0.04], leukopenia [RR=0.19(0.06,0.62), P=0.006]; there was no statistical significance in total remissions at the twelfth month.Conclusion Compared with cyclophosphamide in the treatment of idiopathic membranous nephropathy, tacrolimus group has obvious advantages in short-term efficacy, but long-term efficacy remains to be seen.