The following is a summary of “Efficacy and safety of low-dose corticosteroids combined with leflunomide for progressive IgA nephropathy: a systematic review and meta-analysis,” published in the March 2024 issue of Urology by Zhang et al.
The management of Immunoglobulin A (IgA) nephropathy (IgAN) presents ongoing challenges, with the efficacy of immunosuppressive and corticosteroid therapies continually under scrutiny. To address this, the researchers conducted a comprehensive meta-analysis aiming to assess the effectiveness and safety of a combined regimen involving low-dose corticosteroids and leflunomide for progressive IgA nephropathy.
The methodology involved thorough searches of PubMed, Embase, and the Cochrane Library databases, supplemented by manual screening of references from relevant studies, all adhering to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) checklist. Eligibility criteria were established using the PICOS framework.
The analysis, incorporating data from three selected articles and encompassing 342 patient cases, revealed notable outcomes. Specifically, the combination therapy of low-dose corticosteroids and leflunomide demonstrated efficacy in mitigating urine protein excretion (UPE), with a significant mean difference (MD) of -0.35 (95% CI: -0.41 to -0.30, P < 0.00001) compared to the full-dose corticosteroids group.
However, no discernible differences were observed between the groups concerning serum creatinine (SCr), estimated glomerular filtration rate (eGFR), complete remission rate, and overall response rate (p > 0.05). Moreover, the combined therapy exhibited a favorable safety profile, significantly reducing the risk of serious adverse events (odds ratio [OR]: 0.11, 95% CI: 0.01 to 0.91, P = 0.04). Notably, no significant disparities were noted between the two groups regarding various adverse events, including respiratory infections, abnormal liver function, diarrhea, herpes zoster, alopecia, pruritus, insomnia, pneumonia, diabetes, and urinary tract infections (P > 0.05).
In conclusion, the meta-analysis underscores the efficacy and safety of low-dose corticosteroids combined with leflunomide as a viable therapeutic approach for managing progressive IgA nephropathy.
Source: bmcurol.biomedcentral.com/articles/10.1186/s12894-024-01438-3