The Efficacy And Safety Of The Treatment In Middle-severe IgA Nephropathy By Mycophenolate Mofetil Versus Cyclophosphamide:A Meta-analysis

Objective The aim of this meta-analysis is to investigate the efficacy and safety of mycophenolate mofetil versus cyclophosphamide in the treatment of middle-severe IgA nephropathy by searching and analyzing all relevant published literatures, providing references for settling on treatment plans.Methods Two independent investigators systematically searched the CNKI, Wanfang database, VIP database, Cochrane library, EMBASE and Pubmed according to established search strategy for all relevant literatures published in English or Chinese up to November 2015. The Jadad scale was used for assessing the qualities of included articles. The effect sizes of continuous data are standardized mean difference(SMD) or weighted mean difference(WMD) with respective 95% confidence interval(CI). The effect size of binary data is relative risk(RR) with its 95% confidence interval. Z-test was used to evaluate the total effect. The heterogeneity was measured by a chi-square test(?2) and I-squared statistic(I2). Fixed effect model was adopted during the data analysis when p>0.05, otherwise, random effect model was chosen. The publication bias was explored by funnel plots by Begg's test and Egger's test. Statistic analyses were performed on Stata software(version 12.0).Results Eight eligible studies with control group by CTX combined with glucocorticoids were included finally. All studies were performed in China and no foreign studies met inclusion criteria in this meta-analysis. The results of statistic analyses are shown as follows:(1) Both overall effective rate and complete remission rate in MMF group are significantly higher than CTX group [RR=1.37, 95%CI(1.19-1.58), p=0.000; RR=1.91, 95%CI(1.41-2.58), p=0.000](2) There are statistically significant differences in UP, albumin(Alb) and the decline of serum creatinine(?Scr) between MMF group and CTX group at the end of follow-up [WMD=-0.49, 95%CI(-0.80--0.17), p=0.003; WMD=5.24, 95%CI(3.97-6.50), p=0.000; WMD =63.19, 95%CI(44.09-82.29), p=0.000].(3) There are no statistically significant differences in the incidence rates of the most common adverse events between MMF group and CTX group [pneumonia: RR=1.78, 95%CI(0.69-4.6),p=0.234;impaired liver function: RR=0.47, 95%CI(0.18-1.18), p=0.109; leukopenia: RR=0.45, 95%CI(0.14-1.48), p=0.188;digestive reactions: RR=0.34, 95%CI(0.11-1.06), p=0.135; varicella-zoster virus infection: RR=0.74, 95%CI(0.19-2.86), p=0.658].Conclusions Compared to cyclophosphamide, mycophenolate mofetil can better protect renal function and promote clinical remission with a lower incidence of side effects in the treatment of middle-severe IgA nephropathy.