Comparison of Dosage of Glucocorticoid in Idiopathic Membranous Nephropathy: A Systematic Review and Network Meta-Analysis

Yanhua Li; Ziqing Gao; Jianhong Zhu; Jianan Su; Pengwei Chen; Jiande Li; Min Feng

doi:10.7759/cureus.51936

Comparison of Dosage of Glucocorticoid in Idiopathic Membranous Nephropathy: A Systematic Review and Network Meta-Analysis

Cureus. 2024 Jan 9;16(1):e51936. doi: 10.7759/cureus.51936. eCollection 2024 Jan.

Authors

Yanhua Li¹, Ziqing Gao², Jianhong Zhu³, Jianan Su², Pengwei Chen², Jiande Li⁴, Min Feng²

Affiliations

¹ Department of Rheumatology, Nanhai District People's Hospital, Foshan, CHN.
² Department of Nephrology, Sun Yat-sen Memorial Hospital, Guangzhou, CHN.
³ Department of Pharmacy, Sun Yat-sen Memorial Hospital, Guangzhou, CHN.
⁴ Department of Pain Management, The First People's Hospital of Foshan, Foshan, CHN.

Abstract

Purpose: Idiopathic membranous nephropathy (IMN) with moderate risk or above was recommended to receive immunosuppressive therapy. We attempted to evaluate the optimal dose of glucocorticoid when combined with evidence-proven effective immunosuppressants by network meta-analysis.

Methods: A systematic review of the literature was conducted in PubMed, Embase, Cochrane Library, and ClinicalTrials.gov from inception until January 2022. Randomized controlled trials (RCTs) in IMN limited to supportive care, glucocorticoids, cyclophosphamide, chlorambucil, calcineurin inhibitors (CNIs), and rituximab were screened.

Results: Twenty-eight RCTs of 1,830 patients were included. Therapeutic regimens were divided as follows: moderate- to high-dose glucocorticoids plus CNIs (HMSCn), moderate- to high-dose glucocorticoids plus cyclophosphamide (HMSCt), moderate- to high-dose glucocorticoids plus chlorambucil (HMSCh), zero- to low-dose glucocorticoids plus CNIs (LNSCn), zero- to low-dose glucocorticoids plus cyclophosphamide (LNSCt), rituximab alone (R), glucocorticoids alone (SE), and supportive care alone (SP). Compared with SP, HMSCh (risk ratio [RR]: 1.77, 95% confidence interval [CI]: 1, 3.18), HMSCn (RR: 2.5, 95%CI: 1.25, 5.11), HMSCt (RR: 2.15, 95%CI: 1.29, 3.64), LNSCn (RR: 2.16, 95%CI: 1.25, 3.95), and R (RR: 2.07, 95%CI: 1, 4.39) had a higher probability of total remission rate, while HMSCn represented the highest probability depending on the surface under the cumulative ranking area (SUCRA) ranking values. Regarding infection, no significant difference was found between different doses of glucocorticoids plus the same immunosuppressant. HMSCn and HMSCt showed superiority in reducing 24-hour urine total protein compared with HMSCh, LNSCn, SE, and SP, while HMSCn seemed to be the most effective regimen through the ranking of SUCRA value.

Conclusion: Moderate- to high-dose glucocorticoids showed superiority in proteinuria remission when combined with CNIs in IMN, with no increasing risk of infection.

Keywords: glucocorticoid; idiopathic membranous nephropathy; immunosuppressant; network meta-analysis; systematic review.

Publication types

Review