| Objective:To evaluate the efficacy and safety of mycophenolate mofetil versus cyclophosphamide in adults with refractory nephrotic syndrome.Methods:The randomized controlled trials of mycophenolate mofetil and cyclophosphamide treatment of refractory nephrotic syndrome were searched from Cochrane library, PubMed, EMbase, wanfang, VIP and CNKI till March2014. Then we screened relevant studies according to inclusion criteria and exclusion criteria, evaluated the quality of the included studies, and performed meta-analyses by using RevMan5.2software, analysised the complete remission rate, efficiency, serum albumin, and adverse reaction after treatment for adults with refractory nephrotic completeResult:There were9RCTs, a total of467patients enrolled. The result of the meta-analysis showed that mycophenolate mofetil can significantly increase complete remission rate (RR=1.45,95%CI (1.17,1.81), P=0.0007), efficiency (RR=1.23,95%CI (1.11,1.36), P<0.0001), enhance the level of serum albumin (WMD=2.73,95%CI (1.42,4.04), P<0.0001) and lower24h urinary protein (SMD=-0.63,95%CI (-1.16,-0.10), P=0.02) compared with cyclophosphamide in the treament of refractory nephrotic syndrome; while improving serum cholesterol (SMD=0.31,95%CI (-0.23,0.84), P=0.26) was not statistically significant. Cyclophosphamide in patients with alopecia [RR=0.08,95%CI (0.02,0.29), P<0.00001], liver dysfunction [RR=0.13,95%CI (0.06,0.28), P<0.00001], leukopenia [RR=0.10,95%CI (0.04,0.23), P0.00001] and gastrointestinal tract [RR=0.21,95%CI (0.11,0.39), P<0.00001] had a higher incidence with the mycophenolate mofetil group, but there were no differences in respiratory tract infection [RR=0.68,95%CI (0.41,1.14), P=0.14] and lung infection [RR=0.58,95%CI (0.31,1.08), P=0.09] between the two groups.Conclusion:Efficacy of mycophenolate mofetil in patients with refractory nephrotic syndrome was higher than cyclophosphamide, but with a lower incidence of adverse reactions. |
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