| Objectives: To evaluate the efficacy and safety of leflunomide in the treatment of purpuric nephritis.Methods: All the data of randomized controlled trials(RCTs)involving leflunomide(LEF)in the treatment of Henoch Schonlein purpura nephritis(HSPN)included in Pubmed,EMbase,OVID,Chinese Biomedical Literature Database(CBM),China Journal Full-text Database(CNKI),Wanfang Database and VIP Data were searched with computer.Literature screening was carried out according to inclusion and exclusion criteria,and data collection and quality evaluation were conducted for inclusion studies.This meta-analysis was performed with Revman 5.3 software.Results: After screening,a total of 18 RCTs included 1007 patients met the criteria,included 504 cases in the experimental group and 503 cases in the control group.The experimental groups were treated with glucocorticoid and LEF,and the control groups were treated with glucocorticoid alone or glucocorticoid combined with mycophenolate mofetil(MMF),or CyclophoSphamide(CTX),or tripterygium glycosides(TG).Meta-analysis showed that in follow-up for 3 months,the experimental group increased serum albumin(ALB),reduced 24-hour urinary protein quantification,complete remission rateand overall efficiency were superior to control group(P<0.05).Subgroup analysis showed that ALB was higher in the GC+LEF group than that in the GC group [SMD=3.54,95%CI(2.12,4.96),P<0.00001],and in the group of GC+CTX[SMD=2.36,95%CI(1.49,3.22),P<0.00001],and the difference was not statistically significant compared with the GC+MMF group [SMD = 2.76,95% CI(-1.01,6.53),P=0.15].The GC+LEF group had a lower 24-hour urine protein quantitation than that in the group of GC [SMD=-0.78,95%CI(-1.09,-0.48),P<0.00001],and in the group of GC+CTX [SMD=-0.92,95 %CI(-1.59,-0.24),P=0.008];compared with GC+TG and GC+MMF,the difference was not statistically significant [SMD=-0.1,95% CI(-0.65,0.46),P=0.74],[SMD=-0.69,95%CI(-1.66,0.27),P=0.16].The complete response rate of in the GC+LEF group was superior to that of the GC group [OR=2.94,95% CI(1.53,5.65),P=0.001];however,the difference was not statistically significant compared with the GC+TG group [OR=1.78,95% CI(0.52,6.09),P=0.36].The overall efficiency of GC+LEF group was better than that of GC group [OR=3.90,95%CI(1.91,7.98),P=0.0002];but the difference was not statistically significant compared with GC+TG group [OR=3.63,95% CI(0.66,20.11),P=0.14].At the follow-up of 6 months,the complete response rate and overall efficiency of the experimental group were better than the control group(P<0.05).Subgroup analysis showed that the complete remission rate in the GC+LEF group was superior to that in the GC group [OR=2.91,95% CI(1.14,7.40),P=0.02],and in GC+CTX group [OR=2.08,95% CI(1.34,3.25),P=0.001],and the difference was not statistically significant compared with theGC + MMF group [OR = 1.27,95% CI(0.33,4.95),P=0.73].The overall efficiency of GC+LEF group was better than that of GC group [OR=7.10,95%CI(1.46,34.38),P=0.01],and in GC+CTX group [OR=2.75,95% CI(1.15,6.59),P=0.02],and the difference was not statistically significant compared with the GC+MMF group [OR=1.32,95% CI(0.31,5.71),P=0.71].In terms of safety: The adverse reactions in the experimental group were lower than those in the control group(P<0.00001).Subgroup analysis showed that the incidence of adverse reactions in the GC+LEF group was lower than that in the GC+TG group [OR=0.18,95% CI(0.07,0.44),P=0.0002],lower than the GC+CTX group [OR=0.19,95% CI(0.12,0.30),P<0.00001],and there was no significant difference compared with GC+MMF group [OR=0.45,95% CI(0.07,2.76),P=0.39].The most common adverse reactions in the GC+LEF group were transaminases elevated and gastrointestinal reactions.Conclusions: GC+LEF had better effect than GC+CTX or GC+TG or GC alone in the treatment of purpuric nephritis;in terms of safety,GC+LEF had less adverse reactions than that in groups of GC+(CTX/TG). |
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