Efficacy and Safety of Mycophenolate Mofetil for Henoch-Schonlein Purpura Nephritis: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

 XIONGJia-chuan ¹ , TIANMao-lu ¹ , HEZhao-xia ¹ , WUHong-mei ² ,  HUZhang-xue ¹

1. Department of Nephrology, West China Hospital, Sichuan University, Chengdu 610041, China;
2. The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding?author：

HUZhang-xue, Email: hzxawy@hotmail.com

Keywords：

Mycophenolate mofetil; Cyclophosphamide; Henoch-Schonlein purpura nephritis; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20140033

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Objective To systematically review the efficacy and safety of mycophenolate mofetil (MMF) for Henoch-Schonlein purpura nephritis (HSPN). Methods Databases such as PubMed, EMbase, CENTRAL, VIP, CNKI, CBM and WanFang Data were electronically searched for comprehensively collecting the randomized controlled trials (RCTs) on the efficacy and safety of MMF for HSPN from inception to December, 2013. Two reviewers independently screened studies according to the inclusion and exclusion criteria, extracted data and evaluated the methodological quality of the included studies. Then meta-analysis was performed using RevMan 5.1 software. Results A total of 10 RCTs involving 426 patients (231 in the trial group and 195 in the control group) were included. The trial group was treated with MMF and corticosteroids, and the control group was treated with corticosteroids monotherapy or combined with cyclophosphamide (CTX), leflunomide (LEF), or azathioprine (AZA). The results of meta-analysis showed that, as for efficacy, no significant difference was found between the two groups after six-mouth treatment (OR=1.36, 95%CI 0.67 to 2.73, P=0.85), while after twelve-mouth treatment, MMF was superior to CTX with a significant difference (OR=6.58, 95%CI 2.45 to 17.33, P=0.002). In addition, the efficacy of MMF was still superior to the azathioprine group, but not better than either LEF or prednisone monotherapy. Lower incidence of side effects were found in the MMF group, compared with the CTX group (OR=0.25, 95%CI 0.13 to 0.45, P < 0.000 01) and the prednisone monotherapy group (OR=0.26, 95%CI, 0.09 to 0.79, P=0.02), while there was no significant difference between the MMF group and the LEF group in side effects. Conclusion Based on the current evidence, the efficacy of MMF for HSPN is better than CTX, and its side effects are less than those of CTX and prednisone.

Citation： XIONGJia-chuan, TIANMao-lu, HEZhao-xia, WUHong-mei, HUZhang-xue. Efficacy and Safety of Mycophenolate Mofetil for Henoch-Schonlein Purpura Nephritis: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2014, 14(2): 184-190. doi: 10.7507/1672-2531.20140033 Copy

1.	Saulsbury FT. Henoch-Schonlein purpura. Curr Opin Rheumatol, 2001, 13(1):35.
2.	Sinclair P. Henoch-sch?nlein purpura-a review:review article. Curr Allergy Clin Im, 2010, 23(3):116-120.
3.	Saulsbury FT. Henoch-Schonlein purpura in children:Report of 100 patients and review of the literature. Medicine, 1999, 78(6):395.
4.	Fervenza FC. Henoch-Sch?nlein purpura nephritis. Int J Dermatol, 2003, 42(3):170-177.
5.	Narchi H. Risk of long term renal impairment and duration of follow up recommended for Henoch-Sch?nlein purpura with normal or minimal urinary findings:a systematic review. Arch Dis Child, 2005, 90(9):916-920.
6.	Davin J C, Weening J. Henoch-Sch?nlein purpura nephritis:an update. Eur J Pediatr, 2001, 160(12):689-695.
7.	Jauholo O, Ronkainen J, Koskimies O, et al. Renal manifestations of Henoch-Sch?nlein purpura in a 6-month prospective study of 223 children. Arch Dis Child, 2010, 95(11):877-882.
8.	Koskimies O, Mir S, Rapola J, et al. Henoch-Sch?nlein nephritis:long-term prognosis of unselected patients. Arch Dis Child, 1981, 56(6):482-484.
9.	Faedda R, Pirisi M, Satta A, et al. Regression of Henoch-Sch?nlein disease with intensive immunosuppressive treatment. Clin Pharmacol Ther, 1996, 60(5):576-581.
10.	Deng F, Lu L, Zhang Q, et al. Improved Outcome of HenochSchonlein Purpura Nephritis by Early Intensive Treatment. Indian J Pediatr, 2012, 79(2):207-212.
11.	Peru H, Soylemzoglu O, Bakkaloglu SA, et al. Henoch Schonlein purpura in childhood:clinical analysis of 254 cases over a 3-year period. Clin Rheumatol, 2008, 27(9):1087-1092.
12.	Villarroel M, Hidalgo M, Jimeno A. Mycophenolate mofetil:An update. Drug Today(Barcelona, Spain:1998), 2009, 45(7):521.
13.	van Gelder T, Meur YL, Shaw LM, et al. Therapeutic drug monitoring of mycophenolate mofetil in transplantation. Ther Drug Monit, 2006, 28(2):145.
14.	Kawasaki Y. The pathogenesis and treatment of pediatric HenochSch?nlein purpura nephritis. Clin Exp Nephrol, 2011, 15(5):648-657.
15.	Dudley J, Smith G, Llewellyn-Edwards A, et al. Randomised placebo controlled trial to assess the role of early prednisolone on the development and progression of Henoch-Schonlein purpura nephritis. Pediatr Nephrol, 2007, 22(9):1457.
16.	Mills JA, Michel BA, Bloch DA, et al. The American College of Rheumatology 1990 criteria for the classification of Henoch-Sch?nlein purpura. Arthritis Rheum, 1990, 33(8):1114-1121.
17.	Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5. 1. 0[updated March 2011]. The Cochrane Collaboration, 2011.
18.	Fuentes Y, Valverds S, Velasquez-Jones L, et al. Comparison of azathioprine vs. mofetil mycofenolate for henoch-schonlein nephritis treatment. Pediatr Nephrol, 2010, 25(9):1802.
19.	俞全勝, 朱光華, 何威遜, 等.霉酚酸酯與環磷酰胺治療腎病綜合征型紫癜性腎炎療效比較.臨床兒科雜志, 2007, 25(4):271-273.
20.	孫劍, 張浩, 劉紀實, 等.來氟米特與霉酚酸酯治療表現為腎病綜合征的過敏紫癜性腎炎的療效比較.中國中西醫結合腎病雜志, 2008, 9(8):691-693.
21.	李英, 桂明, 李楊.免疫抑制劑治療腎病綜合征型紫癜腎炎的臨床療效比較.臨床醫學工程, 2011, 18(3):347-349.
22.	杜悅, 吳玉斌, 李心瑤.霉酚酸酯與環磷酰胺沖擊療法治療兒童紫癜性腎炎的療效比較.中國醫科大學學報, 2010, 5(3):352-355.
23.	林炯程, 胡偉新, 唐政, 等.霉酚酸酯與環磷酰胺治療重癥過敏紫癜性腎炎的療效比較.腎臟病與透析腎移植雜志, 2005, 14(6):508-513.
24.	潘月玲.霉酚酸酯聯合激素治療成人紫癜性腎炎的臨床研究.中國實用醫藥, 2010, 33(1):48-49.
25.	王康, 沈彥波, 徐崇松.嗎替麥考酚酯聯合低分子肝素鈣治療原發性難治性腎病綜合征.中國保健, 2008, 16(27):1291-1294.
26.	Ren P, Han F, Chen L, et al. The combination of mycophenolate mofetil with corticosteroids induces remission of Henoch-Schonlein purpura nephritis. Am J Nephrol, 2012;36:271-277.
27.	麥水強, 龐國象, 李有國.霉酚酸酯治療紫癜性腎炎的臨床觀察.中國誤診學雜志2009, 9(22):5348-5349.
28.	Kidney Disease:Improving Global Outcomes(KDIGO)Glomerulonephritis Work Group. KDIGO Clinical Practice Guideline for Glomerulonephritis. Kidney Int, Suppl, 2012, 2(2):139-274.

1. Saulsbury FT. Henoch-Schonlein purpura. Curr Opin Rheumatol, 2001, 13(1):35.
2. Sinclair P. Henoch-sch?nlein purpura-a review:review article. Curr Allergy Clin Im, 2010, 23(3):116-120.
3. Saulsbury FT. Henoch-Schonlein purpura in children:Report of 100 patients and review of the literature. Medicine, 1999, 78(6):395.
4. Fervenza FC. Henoch-Sch?nlein purpura nephritis. Int J Dermatol, 2003, 42(3):170-177.
5. Narchi H. Risk of long term renal impairment and duration of follow up recommended for Henoch-Sch?nlein purpura with normal or minimal urinary findings:a systematic review. Arch Dis Child, 2005, 90(9):916-920.
6. Davin J C, Weening J. Henoch-Sch?nlein purpura nephritis:an update. Eur J Pediatr, 2001, 160(12):689-695.
7. Jauholo O, Ronkainen J, Koskimies O, et al. Renal manifestations of Henoch-Sch?nlein purpura in a 6-month prospective study of 223 children. Arch Dis Child, 2010, 95(11):877-882.
8. Koskimies O, Mir S, Rapola J, et al. Henoch-Sch?nlein nephritis:long-term prognosis of unselected patients. Arch Dis Child, 1981, 56(6):482-484.
9. Faedda R, Pirisi M, Satta A, et al. Regression of Henoch-Sch?nlein disease with intensive immunosuppressive treatment. Clin Pharmacol Ther, 1996, 60(5):576-581.
10. Deng F, Lu L, Zhang Q, et al. Improved Outcome of HenochSchonlein Purpura Nephritis by Early Intensive Treatment. Indian J Pediatr, 2012, 79(2):207-212.
11. Peru H, Soylemzoglu O, Bakkaloglu SA, et al. Henoch Schonlein purpura in childhood:clinical analysis of 254 cases over a 3-year period. Clin Rheumatol, 2008, 27(9):1087-1092.
12. Villarroel M, Hidalgo M, Jimeno A. Mycophenolate mofetil:An update. Drug Today(Barcelona, Spain:1998), 2009, 45(7):521.
13. van Gelder T, Meur YL, Shaw LM, et al. Therapeutic drug monitoring of mycophenolate mofetil in transplantation. Ther Drug Monit, 2006, 28(2):145.
14. Kawasaki Y. The pathogenesis and treatment of pediatric HenochSch?nlein purpura nephritis. Clin Exp Nephrol, 2011, 15(5):648-657.
15. Dudley J, Smith G, Llewellyn-Edwards A, et al. Randomised placebo controlled trial to assess the role of early prednisolone on the development and progression of Henoch-Schonlein purpura nephritis. Pediatr Nephrol, 2007, 22(9):1457.
16. Mills JA, Michel BA, Bloch DA, et al. The American College of Rheumatology 1990 criteria for the classification of Henoch-Sch?nlein purpura. Arthritis Rheum, 1990, 33(8):1114-1121.
17. Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5. 1. 0[updated March 2011]. The Cochrane Collaboration, 2011.
18. Fuentes Y, Valverds S, Velasquez-Jones L, et al. Comparison of azathioprine vs. mofetil mycofenolate for henoch-schonlein nephritis treatment. Pediatr Nephrol, 2010, 25(9):1802.
19. 俞全勝, 朱光華, 何威遜, 等.霉酚酸酯與環磷酰胺治療腎病綜合征型紫癜性腎炎療效比較.臨床兒科雜志, 2007, 25(4):271-273.
20. 孫劍, 張浩, 劉紀實, 等.來氟米特與霉酚酸酯治療表現為腎病綜合征的過敏紫癜性腎炎的療效比較.中國中西醫結合腎病雜志, 2008, 9(8):691-693.
21. 李英, 桂明, 李楊.免疫抑制劑治療腎病綜合征型紫癜腎炎的臨床療效比較.臨床醫學工程, 2011, 18(3):347-349.
22. 杜悅, 吳玉斌, 李心瑤.霉酚酸酯與環磷酰胺沖擊療法治療兒童紫癜性腎炎的療效比較.中國醫科大學學報, 2010, 5(3):352-355.
23. 林炯程, 胡偉新, 唐政, 等.霉酚酸酯與環磷酰胺治療重癥過敏紫癜性腎炎的療效比較.腎臟病與透析腎移植雜志, 2005, 14(6):508-513.
24. 潘月玲.霉酚酸酯聯合激素治療成人紫癜性腎炎的臨床研究.中國實用醫藥, 2010, 33(1):48-49.
25. 王康, 沈彥波, 徐崇松.嗎替麥考酚酯聯合低分子肝素鈣治療原發性難治性腎病綜合征.中國保健, 2008, 16(27):1291-1294.
26. Ren P, Han F, Chen L, et al. The combination of mycophenolate mofetil with corticosteroids induces remission of Henoch-Schonlein purpura nephritis. Am J Nephrol, 2012;36:271-277.
27. 麥水強, 龐國象, 李有國.霉酚酸酯治療紫癜性腎炎的臨床觀察.中國誤診學雜志2009, 9(22):5348-5349.
28. Kidney Disease:Improving Global Outcomes(KDIGO)Glomerulonephritis Work Group. KDIGO Clinical Practice Guideline for Glomerulonephritis. Kidney Int, Suppl, 2012, 2(2):139-274.

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