A Systematic Review Of Tacrolimus For Idiopathic Nephrotic Syndrome

Objective:To assess the efficacy and safety of tacrolimus for idiopathic nephroticsyndrome.Methods: We searched Pubmed database(1966to December2012),Embasedatabase(1974~2012.12),the Cochrane Central Register of Controlled Trials(December2012), WanFang(1998to December2012),CQVIP(1989to December2012),CNKI(1979toDecember2012) for controlled clinical trials（CCTs）or Randomized, controlled trials(RCTs)of tacrolimus for idiopathic nephrotic syndrome.The data was analysed with RevMan5.1software from the Cochrane Collaboration.Results:12articles were included finally,which contained439patients,among whichGrade A’s articles were2,Grade B’s were8and Grade C’s were2.When analysing theefficience,the studies were divided into two subgroups according to whether pathologic typeswere IMN.In urine protein complete remission aspect,the results of Meta analysisshowed:Compared to control group tacrolimus group was more effective in treatingidiopathic membrance nephropathy[RR=1.69,95%CI(1.06,2.69),P=0.03] and otherpathological types [RR=1.21,95%CI(1.03,1.44), P=0.02].In urine protein partial remissionaspect,the analysis results showed: Compared to control group tacrolimus group was moreeffective in treating idiopathic membrance nephropathy[RR=1.46,95%CI(1.04,2.04),P=0.03],but for other pathological types,there was no difference between tacrolimus andcontrol groups[RR=0.72,95%CI(0.33,1.58), P=0.42].The adverse of glucose intolerance washigher than control group (p<0.05).The incidence of other drug adverse events,such asinfection, nephrotoxicity, gastrointestinal reaction,elevated blood pressure and hepatotoxicity,was similar with control group(p>0.05).The disposition of spots was nearly symmetric onthe funnel map,which suggests that there was no publication bias in the included studies.Conclusion: Tacrolimus was more effective in treating idiopathic nephrotic syndromeand other pathological types in elevating urinary protein complete remission rate.But onlyIMN group’s partial remission rate was elevated significantly.The adverse of glucoseintolerance was higher than control group.The incidence of other drug-related adverseevents,such as infection, nephrotoxicity, gastrointestinal reaction,elevated blood pressure and hepatotoxicity,was similar with control group.