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Published in: International Urology and Nephrology 6/2019

01-06-2019 | IgA Vasculitis | Nephrology-Review

The efficacy and safety of immunosuppressive agents plus steroids compared with steroids alone in the treatment of Henoch–Schönlein purpura nephritis: A meta-analysis

Authors: Jiaxing Tan, Yi Tang, Zhengxia Zhong, Siyu Yan, Li Tan, Padamata Tarun, Wei Qin

Published in: International Urology and Nephrology | Issue 6/2019

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Abstract

Background

Henoch–Schönlein purpura nephritis (HSPN) is the most severe symptom of Henoch–Schönlein purpura. The role of immunosuppressive agents combined with steroids is controversial in treating HSPN. Our meta-analysis was performed to assess the efficacy and safety of the combined therapy in the treatment of HSPN compared with steroids alone.

Methods

Cochrane Library, Pubmed, Embase, and Web of Science were searched and Newcastle–Ottawa Scale was used to assess the quality of the literatures. Odds ratios (OR) and standard mean difference (SMD) with a 95% confidence interval (CI) were used for dichotomous and continuous variables. A random-effect model or fixed-effect analysis was applied according to heterogeneity.

Results

A total of 9 articles were selected in our study. HSPN patients treated with combined therapy demonstrated a significant increase in complete remission rates (OR = 1.95; 95% CI 1.17–3.23, P = 0.010) and total remission rates (OR = 2.30 95% CI 1.33–3.98, P = 0.003) when compared with steroids alone. Children seemed to benefit more from combined treatment (OR = 2.45; CI 1.20–5.02, P = 0.014) than adults (OR = 1.56; CI 0.76–3.20, P = 0.225). Additionally, immunosuppressants plus steroids had an advantage on decreasing proteinuria (SMD = 0.28; CI 0.05–0.52, P = 0.019) and increasing the level of serum albumin (SMD = 0.98; CI 0.35–1.60, P = 0.002). However, significant differences were not found in the estimated glomerular filtration rate (eGFR) and rates of side-effects.

Conclusion

Administration of immunosuppressive agents combined with steroids may be a superior alternative for HSPN. Nevertheless, long-term, high-quality, large-sample, and multicenter RCTs are required to make the results more convincing.
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Literature
4.
go back to reference Pillebout E, Thervet E, Hill G, Alberti C, Vanhille P, Nochy D (2002) Henoch–Schonlein Purpura in adults: outcome and prognostic factors. J Am Soc Nephrol 13(5):1271–1278CrossRefPubMed Pillebout E, Thervet E, Hill G, Alberti C, Vanhille P, Nochy D (2002) Henoch–Schonlein Purpura in adults: outcome and prognostic factors. J Am Soc Nephrol 13(5):1271–1278CrossRefPubMed
8.
12.
go back to reference Kawasaki Y, Suzuki J, Suzuki H (2004) Efficacy of methylprednisolone and urokinase pulse therapy combined with or without cyclophosphamide in severe Henoch–Schoenlein nephritis: a clinical and histopathological study. Nephrology, dialysis, transplantation: official publication of the European dialysis and transplant association. Eur Ren Assoc 19(4):858–864. https://doi.org/10.1093/ndt/gfg617 CrossRef Kawasaki Y, Suzuki J, Suzuki H (2004) Efficacy of methylprednisolone and urokinase pulse therapy combined with or without cyclophosphamide in severe Henoch–Schoenlein nephritis: a clinical and histopathological study. Nephrology, dialysis, transplantation: official publication of the European dialysis and transplant association. Eur Ren Assoc 19(4):858–864. https://​doi.​org/​10.​1093/​ndt/​gfg617 CrossRef
16.
go back to reference Lu Z, Song J, Mao J, Xia Y, Wang C (2017) Evaluation of mycophenolate mofetil and low-dose steroid combined therapy in moderately severe Henoch–Schonlein purpura nephritis. Med Sci Monit 23:2333–2339CrossRefPubMedPubMedCentral Lu Z, Song J, Mao J, Xia Y, Wang C (2017) Evaluation of mycophenolate mofetil and low-dose steroid combined therapy in moderately severe Henoch–Schonlein purpura nephritis. Med Sci Monit 23:2333–2339CrossRefPubMedPubMedCentral
21.
go back to reference Coppo R, Mazzucco G, Cagnoli L, Lupo A, Schena FP (1997) Long-term prognosis of Henoch–Schonlein nephritis in adults and children. Italian group of renal immunopathology collaborative study on Henoch–Schonlein purpura. Nephrology, dialysis, transplantation: official publication of the European dialysis and transplant association. Eur Ren Assoc 12(11):2277–2283 Coppo R, Mazzucco G, Cagnoli L, Lupo A, Schena FP (1997) Long-term prognosis of Henoch–Schonlein nephritis in adults and children. Italian group of renal immunopathology collaborative study on Henoch–Schonlein purpura. Nephrology, dialysis, transplantation: official publication of the European dialysis and transplant association. Eur Ren Assoc 12(11):2277–2283
26.
go back to reference Audemard-Verger A, Terrier B, Dechartres A, Chanal J, Amoura Z, Le Gouellec N, Cacoub P, Jourde-Chiche N, Urbanski G, Augusto JF, Moulis G, Raffray L, Deroux A, Hummel A, Lioger B, Catroux M, Faguer S, Goutte J, Martis N, Maurier F, Riviere E, Sanges S, Baldolli A, Costedoat-Chalumeau N, Roriz M, Puechal X, Andre M, Lavigne C, Bienvenu B, Mekinian A, Zagdoun E, Girard C, Berezne A, Guillevin L, Thervet E, Pillebout E (2017) Characteristics and management of IgA vasculitis (Henoch–Schonlein) in adults: data from 260 patients included in a French multicenter retrospective survey. Arthritis Rheumatol 69 (9):1862–1870. https://doi.org/10.1002/art.40178 CrossRefPubMed Audemard-Verger A, Terrier B, Dechartres A, Chanal J, Amoura Z, Le Gouellec N, Cacoub P, Jourde-Chiche N, Urbanski G, Augusto JF, Moulis G, Raffray L, Deroux A, Hummel A, Lioger B, Catroux M, Faguer S, Goutte J, Martis N, Maurier F, Riviere E, Sanges S, Baldolli A, Costedoat-Chalumeau N, Roriz M, Puechal X, Andre M, Lavigne C, Bienvenu B, Mekinian A, Zagdoun E, Girard C, Berezne A, Guillevin L, Thervet E, Pillebout E (2017) Characteristics and management of IgA vasculitis (Henoch–Schonlein) in adults: data from 260 patients included in a French multicenter retrospective survey. Arthritis Rheumatol 69 (9):1862–1870. https://​doi.​org/​10.​1002/​art.​40178 CrossRefPubMed
Metadata
Title
The efficacy and safety of immunosuppressive agents plus steroids compared with steroids alone in the treatment of Henoch–Schönlein purpura nephritis: A meta-analysis
Authors
Jiaxing Tan
Yi Tang
Zhengxia Zhong
Siyu Yan
Li Tan
Padamata Tarun
Wei Qin
Publication date
01-06-2019
Publisher
Springer Netherlands
Published in
International Urology and Nephrology / Issue 6/2019
Print ISSN: 0301-1623
Electronic ISSN: 1573-2584
DOI
https://doi.org/10.1007/s11255-019-02092-7

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