The efficacy and safety of immunosuppressive agents plus steroids compared with steroids alone in the treatment of Henoch–Schönlein purpura nephritis: A meta-analysis
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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.
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.
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.
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.
KeywordsHenoch–Schönlein purpura nephritis HSPN Immunosuppressive agents Steroids Meta-analysis
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Conflict of interest
The authors declare no conflict of interest in this manuscript.
Research involving human and animal participants
This article does not contain any studies with human participants performed by any of the authors.
- 7.Davin JC, Ten Berge IJ, Weening JJ (2001) What is the difference between IgA nephropathy and Henoch–Schonlein purpura nephritis? Kidney Int 59(3):823–834. https://doi.org/10.1046/j.1523-1755.2001.059003823.x CrossRefGoogle Scholar
- 8.Oh HJ, Ahn SV, Yoo DE, Kim SJ, Shin DH, Lee MJ, Kim HR, Park JT, Yoo TH, Kang SW, Choi KH, Han SH (2012) Clinical outcomes, when matched at presentation, do not vary between adult-onset Henoch–Schonlein purpura nephritis and IgA nephropathy. Kidney Int 82(12):1304–1312. https://doi.org/10.1038/ki.2012.302 CrossRefGoogle Scholar
- 9.Higgins JP, Green S (2008) Cochrane handbook for systematic reviews of interventions: cochrane book series. https://doi.org/10.1002/9780470712184
- 12.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 Google Scholar
- 20.Pillebout E, Alberti C, Guillevin L, Ouslimani A, Thervet E (2010) Addition of cyclophosphamide to steroids provides no benefit compared with steroids alone in treating adult patients with severe Henoch–Schonlein purpura. Kidney Int 78(5):495–502. https://doi.org/10.1038/ki.2010.150 CrossRefGoogle Scholar
- 21.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):2277–2283Google Scholar
- 26.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 CrossRefGoogle Scholar