Meta-analysis of tacrolimus combined with hormone therapy for IgA nephropathy

Objective To evaluate the efficacy and safety of tacrolimus (FK506) combined with hormone therapy for IgA nephropathy.Methods CNKI, CBM, MEDLINE, PubMed, Te Cochrane Library and SCI were searched from the reception to March 2017, and the relevant domestic professional magazines and conference information were manually searched. Randomized controlled trials (RCTs) about the tacrolimus combined with hormone therapy for IgA nephropathy were chosen. By the Cochrane system evaluation method, two reviewers independently selected the literatures according to the inclusion and exclusion criteria. The data were extracted, the quality of the study evaluated, and RevMan 5.3 software was used for meta-analysis.The odds ratio (OR) was used as the effect of the secondary variable data, and the mean difference (MD) as the effect variable.Results Eventually9 RCTs were eligible. Eight RCTs compared with the hormone group and the tacrolimus combined with the hormone group andone RCT compared the tacrolimus group and the tacrolimus group.Meta-analysis showed that:(1) The serum creatinine level in the tacrolimus combined withhormone group with mild to moderate renal impairment was significantly higher than in hormone groupMD=1.00, 95% CI (0.36,1.65), P=0.002. There was no significant difference in serum creatinine between patients with creatinine < 221 μmol/L tacrolimus combined with hormoneMD=-0.77, 95% CI(-6.47, 4.93), P=0.79 There was no significant difference in serum creatinine between tacrolimus combined with hormone group and hormone group when the patient's serum creatinine <221 μmol/L inthestudy.(2) There was no significant difference between the hormone group and tacrolimus combined with hormone group in the total effective rateOR=1.68, 95% CI (0.60, 4.71), P=0.32, complete remission rateOR=1.99, 95% CI (0.91, 4.35), P=0.09, 24 h urinary protein quantificationMD=-0.09, 95% CI (-0.52, 0.34), P=0.68, glomerular filtration rateMD=-2.44, 95% CI (-8.18, 3.30), P=0.40, and the incidence of adverse reactionsOR=0.94, 95% CI (0.59, 1.49), P=0.80.Conclusions Tacrolimus combined with hormone therapy for IgA nephropathy has no significant difference in efficacy and safety as compared with hormone alone, and may result in higher serum creatinine in patients with IgA nephropathy with mild to moderate renal impairment. We expect high-quality, and large-scale multi-center clinical trials to further demonstrate.