Effectiveness and safety of immunosuppressive regimens for adult idiopathic membranous nephropathy: network Meta-analysis

Objective To employ the method of network Meta-analysis for evaluating the effectiveness and safety of immunosuppressive regimens for adult idiopathic membranous nephropathy.Methods The relevant literatures were retrieved from the English databases of Cochrane Library,PubMed,MedLine and Clinical Trial and the Chinese databases of CNKI,Wanfang and VIP Journal from inception until May 30,2020 according to the inclusion and exclusion criteria.Randomized controlled trials(RCTs) of immunosuppressants for adult idiopathic membranous nephropathy were included.Network Meta-analysis was utilized for comparing the advantages of each treatment plan.Results Fifty-one RCTs involving 2955 patients were analyzed.The SUCRA showed that combined regimen of Tripterygium wilfordii & mycophenolate mofetil(MM) fared the best in total remission rate,followed by T.wilfordii,mizoribine,T.wilfordii plus tacrolimus and rituximab regimens.In terms of lowering 24-hour urinary protein,combined regimen of T.wilfordii & MM was optimal,followed T.wilfordii plus tacrolimus,adrenocorticotropic hormone,cyclosporine A plus leflunomide and T.wilfordii.In terms of serum creatinine,T.wilfordii plus MM regimen was ideal,followed by T.wilfordii plus leflunomide,chlorambucil,MM and leflunomide regimens.T.wilfordii regimen was the best in tolerability,followed by tacrolimus,T.wilfordii plus leflunomide,leflunomide and T.wilfordii plus tacrolimus regimens.Conclusion A combination of T.wilfordii polyglycosides and MM is the best solution and more high-quality randomized trials are required for verification.