Clinical Effect of Tripterygium Glycosides Combined with Glucocorticoids in the Treatment of Refractory Nephrotic Syndrome Patients: A Systematic Review and Meta-Analysis

The objective of this study is to evaluate the effectiveness and safety of Tripterygium glycosides combined with glucocorticoids for the treatment of refractory nephrotic syndrome(NS).Computer search of Chinese and English databases,including CNKI,VIP,Wan Fang Database,PubMed,Cochrane Library,Embase,and Sinomed,for randomized controlled trials(RCTs)of Tripterygium glycosides combined with glucocorticoids for refractory NS(RNS)was conducted.Meta-analysis was performed using RevMan5.3.Thirteen RCTs comprising 994 patients were included in the study.Tripterygium glycosides combined with glucocorticoids had a statistical significance on the effective rate(odds ratio[OR]=4.69,95%confidence interval[CI]3.29,6.67,P<0.00001),24-h urine protein(Weighted mean difference(MD)=-0.57,95%CI[-0.62,-0.51],P<0.00001),serum albumin(MD=4.77,95%CI[4.30,5.24],P<0.00001),total serum protein(MD=9.45,95%CI[8.73,10.17],P<0.00001),urea nitrogen(MD=-0.53,95%CI[-0.90,-0.17],P=0.005),and serum creatinine(MD=-8.45,95%CI[-15.32,-1.57],P=0.02).There was no statistical significance on adverse reactions(OR=0.68,95%CI[0.41,1.12],P=0.13).Tripterygium glycosides combined with glucocorticoids could improve clinical effective rate,reduce 24-h urine protein,improve serum albumin and total serum protein,and reduce urea nitrogen and serum creatinine levels in patients with RNS.However,the quality of the included literature is poor,and conclusion still needs further verification using larger samples and high-quality randomized,double-blind controlled trials.

Successful treatment of patients with refractory idiopathic membranous nephropathy with low-dose Rituximab:A single-center experience

BACKGROUND The recognition of idiopathic membranous nephropathy(IMN)as an autoimmune disease has paved the way for the use of B-cell-depleting agents,such as Rituximab(RTX),which is now a first-line drug for treating IMN with proven safety and efficacy.Nevertheless,the usage of RTX for the treatment of refractory IMN remains controversial and challenging.AIM To evaluate the efficacy and safety of a new low-dose RTX regimen for the treatment of patients with refractory IMN.METHODS A retrospective study was performed on refractory IMN patients that accepted a low-dose RTX regimen(RTX,200 mg,once a month for five months)in the Xiyuan Hospital of Chinese Academy of Chinese Medical Sciences’Department of Nephrology from October 2019 to December 2021.To assess the clinical and immune remission data,we performed a 24 h urinary protein quantification(UTP)test and measured the serum albumin(ALB)and serum creatinine(SCr)levels,phospholipase A2 receptor(PLA2R)antibody titer,and CD19+B-cell count every three months.RESULTS A total of nine refractory IMN patients were analyzed.During follow-up conducted twelve months later,the results from the 24 h UTP decreased from baseline[8.14±6.05 g/d to 1.24±1.34 g/d(P<0.05)]and the ALB levels increased from baseline[28.06±8.42 g/L to 40.93±5.85 g/L(P<0.01)].Notably,after administering RTX for six months,the SCr decreased from 78.13±16.49μmol/L to 109.67±40.87μmol/L(P<0.05).All of the nine patients were positive for serum anti-PLA2R at the beginning,and four patients had normal anti-PLA2R titer levels at six months.The level of CD19+B-cells decreased to 0 at three months,and CD19+B-cell count remained at 0 up until six months of follow-up.CONCLUSION Our low-dose RTX regimen appears to be a promising treatment strategy for refractory IMN.