Efficacy and Safety of Tacrolimus versus Cyclosporine A for Idiopathic Membranous Nephropathy:A Network Meta-analysis.

Objective To compare the efficacy and safety of tacrolimus with those of cyclosporine in treating idiopathic membranous nephropathy (IMN) via network meta-analysis. Methods Databases including PubMed,Embase,CENTRAL (Cochrane),Wanfang Database,CNKI,and VIP citation database were searched for relevant studies according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Package Meta 4.5.0 and Gemtc 0.8.1 in R 3.3.1 were used to analyze the included studies. Results In this network meta-analysis,the complete remission rate (RR=0.98,95% CI:0.70-1.40)and the total remission rate (RR=1.00,95% CI:0.90-1.20)of idiopathic membranous nephropathy did not differ significantly between IMN patients treated with cyclosporine A or tacrolimusand,nor did the incidences of hepatic dysfunction(RR=1.40,95% CI:0.52-4.00),infection(RR=0.75,95% CI:0.18-3.10),or gastrointestinal syndrome(RR=2.1,95% CI:0.36-28.00). Conclusion Cyclosporine A seems to have similar effectiveness and safety to tacrolimus in treating IMN.目的 采用网状Meta分析的方法对他克莫司与环孢素A治疗特发性膜性肾病(IMN)的疗效与安全性进行对比分析。方法 依据PRISMA,检索PubMed、Embase、Cochrane CENTRAL、万方数据库、中国知网、维普数据库,并根据以往相关综述和荟萃分析所引用的参考文献进一步检索随机对照试验。采用R3.3.1软件Meta 4.5.0包和Gemtc 0.8.1包对纳入的研究文献进行网状荟萃分析。结果 与他克莫司相比,环孢素A在治疗成人IMN时的完全缓解率(RR=0.98,95% CI:0.70~1.40)或总缓解率(RR=1.00,95% CI:0.90~1.20)差异均无统计学意义。两者在肝功能受损(RR=1.40,95% CI:0.52~4.00)、感染(RR=0.75,95% CI:0.18~3.10)、胃肠道症状(RR=2.1,95% CI:0.36~28.00)等常见不良反应方面差异均无统计学意义。结论 环孢素A与他克莫司治疗成人IMN的缓解率及安全性相当。.