| Objective:Using meta analysis to evaluate the efficacy and safety of leflunomide in the treatment of IgA nephropathy.Methods:By searching PubMed,Cochrane library,Wanfang database,China National Knowledge Internet,Chinese biomedical database,Chinese science and technology vipp database,literature related to the clinical randomized controlled trial of leflunomide in the treatment of IgA nephropathy published domestic and international since the establishment of the library until May 2018 was collected,RevMan 5.2 software was used to conduct statistical analysis and data processing on complete remission rate,total response rate,urinary protein,serum creatinine,serum albumin and adverse reactions of the literatures that met the inclusion criteria,investigating the efficacy and safety of leflunomide compared with other immunosuppressive agents in the treatment of IgA nephropathy.Results:Complete remission rate: LEF combined with GC can improve the complete remission rate of IgA nephropathy compared with GC alone(RR=1.35,95%CI:1.08~1.67,P=0.007).Compared with GC alone,LEF can improve the complete remission rate of IgA nephropathy(RR=2.45,95%CI: 1.08~5.54,P=0.02).LEF combined with GC was similar to CTX combined with GC in terms of complete remission rate(RR=1.09,95%CI: 0.75~1.59,P=0.65).Total remission rate: LEF combined with GC could improve the total remission rate of IgA nephropathy compared with GC alone,(RR=1.20,95%CI: 1.09~1.31,P < 0.0001).The result of LEF compared with GC had similar clinical effect in total remission rate(RR=1.17,95%CI: 0.85~1.61,P=0.33).The total remission rate of LEF combined with GC and CTX combined with GC was similar(RR=1.09,95%CI: 0.96~1.23,P=0.18).Urinary protein: LEF combined with GC was better than GC alone in the treatment of urinary protein of IgA nephropathy(SMD=-0.65,95%CI:-0.81~-0.48,P < 0.01).LEF reduces urinary protein,which showing similar efficacy compared with GC(SMD=0.07,95%CI:-0.30~0.43,P=0.72).LEF combined with GC was better than CTX combined with GC in reducing urinary protein with IgA nephropathy(SMD=-0.29,95%CI:-0.54~-0.04,P=0.02).In the early stage of treatment,LEF combined with GC is superior to GC alone in reducing urinary protein with IgA nephropathy.Serum albumin: LEF combined with GC can improve serum albumin level of IgA nephropathy compared with GC alone(SMD=0.70,95%CI:0.08~1.32,P=0.03).The clinical efficacy of LEF and GC is similar(SMD=0.08,95%CI:-0.28~0.44,P=0.67).LEF combined with GC can improve serum albumin of IgA nephropathy compared with CTX combined with GC(SMD=0.34,95%CI: 0.09~0.59,P=0.008).Serum creatinine: LEF combined with GC can reduce serum creatinine in IgA nephropathy campared with GC alone(SMD=-0.21,95%CI:-0.37~-0.05,P=0.01).The clinical efficacy of LEF combined with GC is similar to CTX combined with GC(SMD=-0.05,95%CI:-0.30~0.20,P=0.69).Adverse reactions: LEF combined with GC showed no significant increase in the incidence of adverse events in IgA nephropathy compared with GC alone.(RR=1.16,95%CI: 0.84~1.61,P=0.37).The incidence of adverse reactions between LEF and GC was similar(RR=1.12,95%CI:0.59~2.14,P=0.73).LEF combined with GC can significantly reduce the rate of adverse reactions in patients with IgA nephropathy compared with CTX combined with GC(RR=0.32,95%CI: 0.22~0.47,P < 0.00001).Conclusions: 1.Compared with GC alone,LEF combined with GC therapy can improve the remission rate of IgA nephropathy,reduce the level of urinary protein,improve serum albumin,improve renal function,and do not increase the incidence of short-term adverse reactions.2.LEF can improve the complete remission rate in IgA nephropathy compared with GC alone.3.Compared with LEF alone,LEF combined with GC can improve the total remission rate of IgA nephropathy,decrease urine protein,improve serum albumin and improve renal function.4.LEF combined with GC can reduce urinary protein,increase serum albumin and reduce the incidence of adverse reactions of IgA nephropathy compared with CTX combined GC. |
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