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.