The Efficacy And Safety Of Mycophenolate Mofetil Plus Glucocorticoid In The Treatment Of Henoch–schonlein Purpura Nephritis

OBJECTIVE: To evaluate the efficacy and safety of mycophenolate mofetil plus glucocorticoid in the treatment of Henoch-schonlein purpura nephritis.METHODS: PubMed,EMbase,CENTRAL,Cochrane Library,ACP Journal Club,OVID,EBSCO,viper,CNKI and Wanfang databases were searched.A comprehensive collection of eligible randomized controlled studies(RCTS)on mycophenolate mofetil treated HSPN from the database establishment to January 2019 was conducted and the literature quality was evaluated using the Cochrane risk bias assessment tool.Meta analysis was performed with Stata 12.0 software to evaluate the efficacy and safety of mycophenolate mofetil in the treatment of HSPN.RESULTS: Here were 13 RCTS studys involving 640 patients included in this research,including 341 patients in the observation group and 299 patients in the control group.The observation group were treated with glucocorticoid + mycophenolate mofetil,while the control group were treated with glucocorticoid + cyclophosphamide or glucocorticoid alone.The results of meta-analysis showed that there was no significant difference between the observation group and the glucocorticoid + cyclophosphamide group in the efficacy of HSPN after 6 months of treatment[OR= 1.791,95% CI(0.942,3.407),P=0.075],but it was better than the glucocorticoid therapy group[OR= 3.210,95% CI(1.018,10.122),P= 0.047].After12 months of treatment,the efficacy of the observation group was significantly better than that of the glucocorticoid + cyclophosphamide group[OR= 4.43,95%CI(2.608,11.917),P=0.000].The adverse reactions of hormone + mycophenolate were less than that of glucocorticoid +cyclophosphamide[OR= 0.122,95%CI(0.040,0.367),P=0.000],however,there was no significant difference compared with the glucocorticoid group[OR=1.112,95%CI(0.337,3.667),P=0.861].CONCLUSION: The efficacy of mycophenolate mofetil combined glucocorticoid compared to cyclophosphamide combined glucocorticoid treatment time shorter than 6 months was no significant difference,but when the treatment time longer than 12 months the efficacy is significantly better than glucocorticoid with cyclophosphamide or glucocorticoid alone therapy.The safety of mycophenolate mofetil combined glucocorticoid is similar with glucocorticoid alone,but significantly better than that of glucocorticoid combined cyclophosphamide treatment plan.