The Efficacy And Safety Of Leflunomide In The Treatment Of IgA Nephropathy

Objectives:IgA nephropathy is the most common primary glomerulonephritis in young people,At present,most treatment strategies are angiotensin converting enzyme inhibitors(ACEI),angiotensin receptor blocker(ARB),glucocorticoids(GC)and Immunosuppressant,such as mycophenolate mofetil(MMF)and cyclophosphamide(CTX).Leflunomide(LEF)is an immunosuppressant that inhibits pyridine synthesis,It has been widely used in kidney disease,such as nephrotic syndrome?lup-us nephritis etc.However,compared to the above treatment plan,the efficacy of leflunomide on IgA nephropathy is not clear.So this paper mainly uses meta analysis to evaluate the efficacy and safety of LEF treatment of IgA nephrovathy.Method:A total of 16 randomized controlled trials of LEF in the treatment of IgA nephropathy in the recent 30 years were collected from pubmed,Cochrane,CKNI,Wanfang,VIP and other databases and analyzed the efficacy and safety of LEF and other immunosuppressants in IgA nephropathy from these studies.Results:1?mitigation rate: LEF ? ACEI / ARB and CTX / MMF have no significant difference in treatment,But the complete remission rate was higher in the LEF combined GC group than in the GC alone group;2?Proteinuria: LEF combined with ACEI / ARB reduced the level of urinary protein in patients with ACEI / ARB alone,and LEF combined with GC also reduced urinary protein.3?There was no difference in albuminuria between LEF group and CTX or MMF group.serum creatinine: There was no significant difference between LEF group and ACEI / ARB,GC,CTX / MMF group,and no significant difference was found between LEF group and GC,CTX / MMF group.4?albumin: LEF combined with GC group can improve albumin level more than GC alone group,and LEF group also can improve albumin level more than CTX group.5?Adverse reactions: There was no significant difference between LEF group and ACEI / ARB,GC group,but the gastrointestinal reaction of LEF group was lighter than that of CTX.Conclusions:LEF combined with ACEI / ARB reduced urinary protein levels of IgA nephropathy more than ACEI / ARB alone,but there was no significant difference between complete remission rate and total remission rate.LEF combined GC has a better complete remission rate than GC alone and is more beneficial in reducing proteinuria and increasing albumin levels.LEF combined GC vs CTX in combination with GC helps to raise patient albumin and reduce adverse reactions.However,large samples,high quality RCTs,and long-term follow-up are still needed to further assess the efficacy and safety of LEF in IgA nephropathy.