来氟米特治疗IgA肾病安全性和有效性的Meta分析

Efficacy and safety of leflunomide for IgA nephropathy:A meta-analysis

目的:评价来氟米特(LEF)治疗Ig A肾病(Ig AN)的安全性和有效性。方法:采用电子检索数据库Medline、Embase、Cochrane Library、Clinical trails和中国生物医学数据库(CBM)、中国知网(CNKI)、中文科技期刊全文数据库(VIP)、万方数据库(wanfang),同时手检国内相关期刊及会议资料,纳入所有含LEF的随机对照试验(RCTs),按照Cochrane中的工具对其进行风险评估,并用Revman 5.3软件对其分析。结果:共纳入11个RCTs,589名患者,Meta分析结果显示LEF+Ped组的完全缓解率[RR 1.40,95%CI(1.02~1.93),P=0.04]、总有效率[RR 1.18,95%CI(1.06~1.32),P=0.004]均优于单用Ped组,不良反应(ADR)发生率无统计学差异。LEF+Ped组与CTX/MMF+Ped组在有效性方面类似,但ADR[RR 0.21,95%CI(0.11~0.39),P<0.000 01]显著少于CTX+Ped组。LEF+ACEI组与单用ACEI组有效性和安全性均无统计学差异,但可降低24 h尿蛋白(UTP),提高白蛋白(Alb)。结论:LEF与CTX、MMF联合Ped治疗Ig AN在有效性方面类似,但优于单用Ped,安全性方面也具有一定优势,可以作为临床的选择之一。

AIM： To evaluate efficacy and safe- ty of leflunomide for the treatment of IgA nephropa- thy （IgAN）. METHODS： Databases including PubMed, MEDLINE, The Cochrane Library, Clini- cal trails and CBM, CNKI, VIP, WanFang Data were searched before May 2016, the domestic con- ference data and relevant published articles were al- so searched manually. All the RCTs were assessed according to risk bias tools. Software Revman5. 3 was used to conduct analysis. RESULTS：A total of 11 RCTs involving 589 patients with IgAN were in- eluded. The results of meta-analyses showed that： There were significant advantages between LEF ＋ Ped and single Ped group in the complete remission rate （ RR = 1.40,95 % CI ： 1.02-1.93, P = 0.04 ）, the overall effective rate （ RR = 1.18,95 % CI ： 1.06- 1.32, P =0.004）. The overall incidence rate of adverse reaction showed no difference. LEF ＋ Ped group and CTX/MMF ＋ Ped showed similar effec- tiveness, but incidence rate of adverse reaction （ RR =0.21,95% CI：0. 11-0.39,P 〈0.000 01 ） in LEF ＋ Ped group was less than CTX ＋Ped group. LEF ＋ ACEI group and ACEI showed similar effectiveness and safety, but leflunomide could lower UTP and in- crease Alb. CONCLUSION： LEF has a similar effectiveness compared with CTX and MMF in treat- ment of IgAN, but it presents better effect and safty than Ped, which is referential for clinical application.