Efficacy and safety of tacrolimus combined with corticosteroids in patients with idiopathic membranous nephropathy: a systematic review and meta-analysis of randomized controlled trials

Int Urol Nephrol. 2022 Oct;54(10):2555-2566. doi: 10.1007/s11255-022-03169-6. Epub 2022 Mar 11.

Abstract

Objective: To explore the efficacy and safety of tacrolimus (TAC) combined with corticosteroids in patients with idiopathic membranous nephropathy (IMN).

Methods: A literature search was performed using Embase, Cochrane Library and PubMed from inception through May 31, 2021. All randomized controlled trials (RCTs) exploring the efficacy and safety of TAC combined with corticosteroids in IMN patients were included based on the inclusion and exclusion criteria. Data analyses were conducted using RevMan software (version 5.4).

Results: Seven RCTs involving 520 patients were included in this meta-analysis. Compared with control treatment, TAC combined with corticosteroids could significantly increase the complete remission (CR) rate, total remission (TR) rate, and serum albumin levels, as well as decrease the proteinuria levels within 6-month treatment, but the advantage did not persist to 12-month treatment. After 18-month treatment, the effect of TAC combined with corticosteroids on increasing CR rate, TR rate, and serum albumin levels was significantly worse than control treatment. The mean time to remission in TAC combined corticosteroids group was significantly shorter than that in the control group. The relapse rate, no response rate, change in estimate of the glomerular filtration rate (eGFR), and overall incidence of adverse reactions showed no significant difference between TAC combined with corticosteroids group and control group. However, TAC combined with corticosteroids did have a higher risk of hand tremor, nephrotoxicity, and glucose intolerance than control treatment.

Conclusion: TAC combined with corticosteroids has a significant therapeutic effect for IMN patients within 1-year treatment, especially in the first 6 months. However, in the longer-term treatment, TAC combined with corticosteroids does not have an advantage. TAC combined with corticosteroids has a higher risk of hand tremor, nephrotoxicity, and glucose intolerance. More high-quality studies are needed to further verify the long-term efficacy and safety of TAC combined with glucocorticoids in IMN patients.

Keywords: Corticosteroids; Idiopathic membranous nephropathy; Meta-analysis; Tacrolimus.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Adrenal Cortex Hormones* / adverse effects
  • Adrenal Cortex Hormones* / therapeutic use
  • Drug Therapy, Combination
  • Glomerulonephritis, Membranous* / complications
  • Glomerulonephritis, Membranous* / drug therapy
  • Glucose Intolerance / chemically induced
  • Glucose Intolerance / drug therapy
  • Humans
  • Immunosuppressive Agents / adverse effects
  • Immunosuppressive Agents / therapeutic use
  • Randomized Controlled Trials as Topic
  • Serum Albumin / analysis
  • Tacrolimus* / adverse effects
  • Tacrolimus* / therapeutic use
  • Treatment Outcome
  • Tremor / chemically induced
  • Tremor / drug therapy

Substances

  • Adrenal Cortex Hormones
  • Immunosuppressive Agents
  • Serum Albumin
  • Tacrolimus