In-Depth Topic Review

Efficacy and Safety of Glucocorticoids Therapy for IgA Nephropathy: A Meta-Analysis of Randomized Controlled Trials
Jun Cheng^a, Xiaohui Zhang^a, Wen Zhang^b, Qiang He^a, Xiaojuan Tao^b, Jianghua Chen<sup>a

a</sup>Kidney Disease Center, First Affiliated Hospital, Medical School, Zhejiang University, and
^bDepartment of Nephrology, Hangzhou Red Cross Hospital, Hangzhou, PR China

Address of Corresponding Author

Am J Nephrol 2009;30:315-322 (DOI: 10.1159/000226129)

  Key Words

• Glucocorticoids
• IgA nephropathy

  Abstract

Background: Published reports examining the efficacy and safety of glucocorticoids for preserving renal function in immunoglobulin A nephropathy (IgAN) have yielded conflicting results. To systematically evaluate the efficacy and safety of glucocorticoids agents for IgAN, we conducted a meta-analysis of the published randomized controlled trials (RCTs). Methods: MEDLINE, EMBASE, the Cochrane Library and article reference lists were searched for RCTs that compared glucocorticoids with placebo and any other non-immunosuppressive agents for treating IgAN. The quality of the studies was evaluated with the method of the intention-to-treat analysis and allocation concealment, as well as with the Jadad method. Meta-analyses were performed on the outcomes of proteinuria and renal survival and adverse events in patients with IgAN. Results: Seven RCTs involving 386 patients were included in the review. Four RCTs reported renal survival data with Kaplan-Meier survival curves. Overall, glucocorticoid agents had statistically significant effects on improved renal survival (HR 0.20, 95% CI 0.20 to 0.39) and reduction of proteinuria (standardized mean difference SMD, –0.51; 95% CI –0.73 to –0.29) when compared with the control group. Tests for heterogeneity showed no difference in effect among the studies. In general, glucocorticoid agents were well tolerated. Patients receiving glucocorticoids therapy did not have an increased risk of development of type 2 diabetes mellitus, hypertension or Cushingoid adverse effects, while glucocorticoids were associated with a significant increase in the risk of gastrointestinal tract adverse events. Conclusions: The current cumulative evidence suggests that glucocorticoids have statistically significant effects on protecting renal function and reduction of proteinuria in patients with IgAN, but we should be careful for its gastrointestinal tract reaction. In general, glucocorticoids agents are a promising medication and should be investigated further.

Copyright © 2009 S. Karger AG, Basel

  Author Contacts

Prof. Jianghua Chen
Kidney Disease Center, The First Affiliated Hospital
College of Medicine, Zhejiang University
Qingchun Road 79, Hangzhou 310003 (PR China)
Tel. +86 571 8723 6992, Fax +86 571 8723 6189, E-Mail chenjianghua@zju.edu.cn

  Article Information

J. Cheng and X. Zhang contributed equally to this work.

Received: February 12, 2009
Accepted: April 28, 2009
Published online: June 23, 2009
Number of Print Pages : 8
Number of Figures : 4, Number of Tables : 4, Number of References : 29