Treatment By Tacrolimus In Idiopathic Membranous Glomerulopathy: A Meta-analysis

[Objective]This study aimed to assess outcomes and adverse events of treatment by tacrolimus for idiopathic membranous nephropathy with meta analysis.[Methods]A literature search was performed for studies about treating membranous nephropathy with tacrolimus between 1980 and 2010. The following outcomes were evaluated:remission rate; relapse rate; adverse events(such as glucose intolerance; diarrhea;tremor and so on).[Results]Six randomized clinical trials of total 216 patients involved in them, which refers to treatment by FK506 (113), or non-FK506(103). The Jaded assessment score is 2-5. Compared with non-FK506,patients treated with FK 506 had better remission rate (six trials,216 patients; OR=3.89:95%CI,2.09-7.26, Z=4.28,P<0.0001), while there was no difference between them in relapse rate (OR=1.38:95%CI,0.53-3.59, Z=0.67, P=0.50); FK506 is more likely to induce the glucose intolerance (OR=6.02: 95%CI,1.99-18.19, Z=3.18,P=0.001).Compared with the FK506 plus Corticosteroid (OR=2.86:95%CI,1.26-6.48, Z=2.51, P=0.01), monotherapy by FK 506 (OR= 5.99:95%CI,2.24-15.99, Z=3.57, P=0.0004)is more effective in treating idiopathic membranous nephropathy(IMN); treatment by FK506 gained higher remission rate than those treated by CTX (OR=3.06:95%CI,1.26-7.40, Z=2.47, P=0.01).However, there is no difference between the remission rate of FK506 versus leflunomide(LEF)(OR=2.97:95%CI,0.87-10.08, Z=1.74, P=0.08).[Conclusions]FK506 is more effective than other treatments(with higher remission rate in treating idiopathic membranous nephropathy).But it has no advantage in improving the relapse rate of IMN. Besides FK506 is more likely to induce glucose intolerance. monotherapy by FK 506 is more effective in treating IMN than combined with Corticosteroid.