Anji Xiong1, Chen Xiong1, Guancui Yang1, Yu Shuai1, Deng Liu1, Linqian He1, Zepeng Guo1, Liangwen Zhang1, Yi Liu2, Yuan Yang3, Beibei Cui2, Shiquan Shuai1. 1. Department of Rheumatology and Immunology, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College, Nanchong, China. 2. Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China. 3. Department of Rheumatology and Immunology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China.
Abstract
Objectives: The successful introduction of mycophenolate mofetil (MMF) as a treatment for renal allograft reduced the incidence of acute rejection. The inspiring effects obtained by the MMF have led to an evaluation of its therapeutic potency on ANCA-associated vasculitis (AAV). However, there is little evidence of the MMF's efficacy on the AAV. The meta-analysis is carried out to evaluate the efficacy of MMF as a remission induction therapy in AAV. Methods: Up to June 30th, 2020, PubMed, Cochrane Library, and Embase have been searched comprehensively. According to heterogeneity, the pooled remission rates are synthesized by either fixed-effect or random-effect models. Results: The eight included studies comprising 230 patients who were treated with MMF as induction therapy are included in our analysis. The pooled overall remission rate is 74% (95% CI: 0.68-0.80). The remission rate, the infection rate and the rate of leukopenia of four randomized controlled trials aimed at comparing the effects of MMF with cyclophosphamide (CYC) during induction therapy for AAV have no statistical significance (P > 0.05). Conclusion: MMF may be an alternative to CYC for remission induction therapy in AAV with MPO-ANCA, mild to moderate renal involvement and non-life-threatening state. Whether to observe the effect of MMF in AAV or to compare the difference between MMF and CYC in the future studies, risk stratification and subgrouping of AAV patients should be first carried out to correctly identify the AAV subgroup suitable for MMF.
Objectives: The successful introduction of mycophenolate mofetil (MMF) as a treatment for renal allograft reduced the incidence of acute rejection. The inspiring effects obtained by the MMF have led to an evaluation of its therapeutic potency on ANCA-associated vasculitis (AAV). However, there is little evidence of the MMF's efficacy on the AAV. The meta-analysis is carried out to evaluate the efficacy of MMF as a remission induction therapy in AAV. Methods: Up to June 30th, 2020, PubMed, Cochrane Library, and Embase have been searched comprehensively. According to heterogeneity, the pooled remission rates are synthesized by either fixed-effect or random-effect models. Results: The eight included studies comprising 230 patients who were treated with MMF as induction therapy are included in our analysis. The pooled overall remission rate is 74% (95% CI: 0.68-0.80). The remission rate, the infection rate and the rate of leukopenia of four randomized controlled trials aimed at comparing the effects of MMF with cyclophosphamide (CYC) during induction therapy for AAV have no statistical significance (P > 0.05). Conclusion:MMF may be an alternative to CYC for remission induction therapy in AAV with MPO-ANCA, mild to moderate renal involvement and non-life-threatening state. Whether to observe the effect of MMF in AAV or to compare the difference between MMF and CYC in the future studies, risk stratification and subgrouping of AAVpatients should be first carried out to correctly identify the AAV subgroup suitable for MMF.
Authors: Rachel B Jones; Thomas F Hiemstra; Jose Ballarin; Daniel Engelbert Blockmans; Paul Brogan; Annette Bruchfeld; Maria C Cid; Karen Dahlsveen; Janak de Zoysa; Georgína Espigol-Frigolé; Peter Lanyon; Chen Au Peh; Vladimir Tesar; Augusto Vaglio; Michael Walsh; Dorothy Walsh; Giles Walters; Lorraine Harper; David Jayne Journal: Ann Rheum Dis Date: 2019-01-05 Impact factor: 19.103
Authors: G S Hoffman; G S Kerr; R Y Leavitt; C W Hallahan; R S Lebovics; W D Travis; M Rottem; A S Fauci Journal: Ann Intern Med Date: 1992-03-15 Impact factor: 25.391