Tacrolimus And Prednisone For Refractory Nephrotic Syndrome: A Systematic Review

Objective：To systematically evaluate the effectiveness and safety of Tacrolimuscombined with prednisone for refractory nephrotic syndrome. Methods：Databasesincluding CBM, CNKI, Wan Fang Data, VIP, MEDLINE, PubMed, The Cochrane Library,EMBASE, Up To Date, were searched from1984Tacrolimus First discovered to June2014, and the relevant magazines and information were also searched manually. Allrandomized controlled trials or quasi-randomized controlled trials on refractory nephroticsyndrome were independently collected and evaluated by two reviewers, according to thepatient’s age that is divided into adult and children, the meta-analysis was performed withRevMan5.2. Results：To adults,11articles were included, which contained593patients,among which high-quality’s articles were2. The results of meta-analysis showed the totalremission: TAC+Pred groups were higher than the control groups, Adverse reaction:gastrointestinal adverse reaction, glucose intolerance were similar with control groups, theover incidence rate of adverse reaction in the TAC+Pred groups were lower than thecontrol groups. To children,6articles were included, which contained354patients, amongwhich high-quality’s articles were2. The results of meta-analysis showed the totalremission: the TAC+Pred groups were higher than the only TAC groups and higher thanthe CTX+Pred groups. Adverse reaction: the over incidence rate of adverse reaction in theTAC+Pred groups were lower than the control groups, the serious incidence rate ofadverse reaction were lower than the control groups, there were no significant differencesin the incidence rate of gastrointestinal adverse reaction. Conclusion: Tacrolimuscombined with prednisone in treating refractory nephrotic syndrome could increase thetotal remission, decrease the over incidence rate of adverse reaction to all adults andchildren. Pathological typing was different: more MCD about children, more MN aboutadults. Based on the limitation of the study, still needed high-quality clinical RCT to befurther proved.