The efficacy and safety of leflunomide combined with low or moderate doses of glucocorticoids in the treatment of chronic progressive IgA nephropathy

doi:10.3877/cma.j.issn.2095-3216.2019.05.004

Abstract

Abstract:

Objective

To evaluate the efficacy and safety of leflunomide combined with low or moderate doses of glucocorticoids in the treatment of chronic progressive IgA nephropathy.

Methods

Randomized controlled trials (RCTs) of leflunomide combined with low or moderate doses of glucocorticoids in the treatment of chronic progressive IgA nephropathy were searched for by PubMed, Cochrane Library, China National Knowledge Internet Full Text Database (CNKI), Chinese Science and Technology Journals VIP Database (VIP), and Wanfang Database. And quality evaluation and meta-analysis were performed on eligible literatures according to the Cochrane tools.

Results

A total of 53 literatures were retrieved, including 39 Chinese literatures and 14 English literatures. 18 literatures were removed through duplicate checking. 15 literatures were removed including reviews, conference papers, and retrospective analysis articles. 13 literatures were removed including the non-RCTs and literatures of poor quality. Eventually, 7 RCTs were enrolled with altogether 385 patients.

Conclusions

Compared with the conventional glucocorticoids treatment, leflunomide combined with low or moderate doses of glucocorticoids reduced the 24-hour urine protein quantitation, improved the glomerular filtration rate, and did not increase the patients′ recent adverse reactions. And compared with the treatment of cyclophosphamide plus glucocorticoids, leflunomide combined with low or moderate doses of glucocorticoids had similar efficacy, and significantly reduced the incidence of adverse reactions.

Key words: Leflunomide, Glucocorticoid, Chronic progressive IgA nephropathy

Yuzhen Chen, Jiayun Xu. The efficacy and safety of leflunomide combined with low or moderate doses of glucocorticoids in the treatment of chronic progressive IgA nephropathy[J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2019, 08(05): 208-212.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhsbyjdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-3216.2019.05.004

https://zhsbyjdzzz.cma-cmc.com.cn/EN/Y2019/V08/I05/208

Figures/Tables 5

References 20

[1]	Berger J. IgA glomerular deposits in renal disease [J]. Transplant Proc, 1969, 1(4): 939-944.
[2]	中华医学会. 临床诊疗指南(肾脏病学分册) [M] .北京：人民卫生出版社，2011.39-43.
[3]	Bartosik LP, Lajoie G, Sugar L, et al. Predicting progression in IgA nephropathy [J]. Am J Kidney Dis, 2001, 38(4): 728-735.
[4]	Radhakrishnan J, Cattran DC. The KDIGO practice guideline on glomerulonephritis: reading between the (guide) lines-application to the individual patient [J]. Kidney Int, 2012, 82(8): 840-856.
[5]	Rosselli J, Hacker S, Karpinski J, et al.Treatment of IgA nephropathy: an update [J]．Ann Pharmacother, 2011, 45(10): 1284-1296.
[6]	胡耀，柯贵宝，向元兵，等. 来氟米特对IgA肾病患者血清血管内皮生长因子和内皮素水平的影响[J]．重庆医学，2018，47(9)：1191-1193.
[7]	彭鲲，洪大情，邹玉蓉，等. 来氟米特联合糖皮质激素治疗IgA肾病的临床研究[J]．临床肾脏病杂志，2014，14(2)：86-89.
[8]	Min L, Wang Q, Cao L, et al. Comparison of combined leflunomide and low-dose corticosteroid therapy with full-dose corticosteroid monotherapy for progressive IgA nephropathy [J]. Oncotarget, 2017, 8(29): 48375-48384.
[9]	曹励欧，倪兆慧，严玉澄，等. 来氟米特联合中小剂量糖皮质激素治疗进展性IgA肾病的研究[J]．上海医学，2009，(9)：791-795.
[10]	董吉，王绪明，王金平，等. 来氟米特联合小剂量泼尼松治疗增殖性IgA肾病效果观察[J]．山东医药，2017，57(28)：51-53.
[11]	黄云霞. 来氟米特联合中小剂量糖皮质激素治疗进展性IgA肾病疗效观察[J]．中国基层医药，2011，18(14)：1965-1966.
[12]	李涛，冯爱桥，刘一卓，等. 来氟米特联合糖皮质激素治疗进展性IgA肾病的研究[J]．现代中西医结合杂志，2011，20(1)：13-15.
[13]	孙铸兴，王凉，刘斌，等. 来氟米特与环磷酰胺治疗伴肾功能减退IgA肾病的疗效对比分析[J]．苏州大学学报(医学版)，2009，29(5)：961-963.
[14]	王凉，孙铸兴. 来氟米特联合强的松治疗慢性进展性IgA肾病疗效分析[J]．苏州大学学报(医学版)，2006，(04)：677-679.
[15]	Miceli-Richard C, Dougados M. Leflunomide for the treatment of rheumatoid arthritis [J]. Expert Opin Pharmacother, 2003, 4(6): 987-997.
[16]	Kirsch BM, Zeyda M, Stuhlmeier K, et al. The active metabolite of leflunomide, A771726, interferes with dendritic cell function [J]. Arthritis Res Ther, 2005, 7(3): R694-R703.
[17]	Grisar J, Aringer M, Köller MD, et al. Leflunomide inhibits transendothelial migration of peripheral blood mononuclear cells [J]. Ann Rheum Dis, 2004, 63(12): 1632-1637.
[18]	王玉柱，周春华. 来氟米特抑制结缔组织生长因子诱导的肾间质成纤维细胞增殖和胶原合成的研究[J]．中国现代医学杂志，2007，(13)：1545-1548.
[19]	焦楠. 来氟米特对PAN损伤足细胞凋亡的保护作用及机制[D]. 山西医科大学，2014.
[20]	苑玉聪. 来氟米特活性代谢产物A771726对高糖诱导足细胞凋亡的影响及机制研究[D]．山西医科大学，2011.

Please choose a citation manager

Content to export