A Systematic Review: Treatment Of Tacrolimus For Membranous Nephropathy

objective :Membranous nephropathy(MN) which is a common type of nephrotic syndrome, has become one of the common cause of end-stage renal disease(ESRD). tacrolimus,as a new immunosuppressant becomes a major focus in the research treatment of membranous nephropathy. The positive effects and few adverse events were found on treatment of tacrolimus for MN in many trails but the Systematic review of tacrolimus for MN is not comprehensive. This review was conducted in order to assess the benefits and harms of the treatment of tacrolimus for MN in nephrotic syndrome patients. Methods : We searched the Cochrane Library, Embase, Medline, and CNKI. When necessary, manual searching was used for abstract and/or original text of possible articles. Pharmaceutical companies were also contacted. All randomized controlled trials(RCTs) or quasi-RCTs comparing treatment of MN with tacrolimus monotherapy against supportive care or tacrolimus combined prednisolone against other drug combined Prednisolone were included with no consideration of dose, follow-up time, the plasma concentration of controlled clinical trials. Revman 5.1 software was used for data analysis. Outcomes, complete remission rate(CR), overall response rate(RR), relapse rate, blood glucose, blood pressure, serum creatinine, liver enzyme levels, blood changes and gastrointestinal reactions, hand tremors, hair loss and other related incidence statistical indicators were measured. The results of statistical analyses were expressed as relative risk(RR) for dichotomous outcomes, with 95% confidence intervals(CI). Results: Initially, 191 articles were found, including 67 English papers,124 Chinese papers. After elementary screening,38 papers remained. Finally met the inclusion criteria included 15 randomized controlled clinical study, 691 patients were included, of whom tacrolimus group of 346 people, 345 people in the control group. While after combination analysis there be significant in complete remission rate, overall response rate, six-month rate of complete remission and six-month rate of overall response rate, while no significant in relapse rate. The trend of more events of hyperglycemia were found in tacrolimus groups did reach significant difference, however,The risk of gastrointestinal reactions, hand tremor, hypertension, elevated creatinine was no significant difference in terms. Liver enzyme abnormalities, bone marrow suppression, urinary tract infections, the incidence of adverse reactions alopecia aspects than the control group, there is a significant difference.Conclusions: The results of meta-analysis implied that, No matter TAC monotherapy comparison routine supportive care, or TAC combined hormone contrast CTX or LEF combined pednisolone short-term effects are better than the control group. TAC will be given priority treatment presence of proteinuria in patients with normal renal function. Prolonged maintenance treatment period, the amount of stepwise reducing TAC treatment may have the effect of reducing the recurrence rate. Adverse reactions, the risk of hyperglycemia higher than control groups, but after TAC reduction or withdrawal of the drug can reduce the adverse effects; in addition to hormones, TAC can reduce the risk of infection compared CTX; tacrolimus terms of the liver enzyme abnormalities,abnormal bone marrow suppression, hair loss occurred significantly lower than the control group. Last, therapeutic plasma concentration during 5 ~ 10 ng / ml, during the sustain blood concentration 2 ~ 5 ng / ml under the conditions of possibility of the emergence of small renal toxicity associated with the drug.The results presented in this review must be interpreted with extreme caution given the limited quality of studies for a single-center study and small numbers of trials evaluated. Studies with high quality and enough sample size, More high-quality research in the future implementation of the recommendations: to grow up follow-time and observation time, to clarify relapse rate and more study endpoints of adverse reactions that improve the relevant arguments in favor of a more comprehensive system for future evaluation.