Brief Article
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Feb 28, 2012; 18(8): 821-832
Published online Feb 28, 2012. doi: 10.3748/wjg.v18.i8.821
Meta-analysis of combined therapy for adult hepatitis B virus-associated glomerulonephritis
Xiao-Yong Zheng, Ri-Bao Wei, Li Tang, Ping Li, Xiao-Dong Zheng
Xiao-Yong Zheng, Ri-Bao Wei, Li Tang, Ping Li, Department of Nephrology, General Hospital of Chinese PLA, Beijing 100853, China
Xiao-Dong Zheng, Department of Ophthalmology, Ehime University School of Medicine, Ehime 791-0295, Japan
Author contributions: Zheng XY and Wei RB contributed equally to this work; Zheng XY and Wei RB designed the research, collected and analyzed the data, wrote and revised the manuscript; Wei RB, Tang L, Li P and Zheng XD participated in data collection; Zheng XD helped in revision of this manuscript.
Supported by National Natural Science Foundation, No. 81072914; Major Project Foundation of National Science and Technology, No. 2010ZX9102-204; Traditional Chinese Medicine Research Grant for Military Organization, No. 10ZYZ255
Correspondence to: Dr. Ri-Bao Wei, Department of Nephrology, General Hospital of Chinese PLA, Beijing 100853, China.
Telephone: +86-10-68717985 Fax: +86-10-66928842
Received: June 9, 2011
Revised: September 13, 2011
Accepted: October 28, 2011
Published online: February 28, 2012

AIM: To investigate the efficacy and safety of combined antiviral and immunosuppressant therapy in adult hepatitis B virus-associated glomerulonephritis (HBV-GN) patients.

METHODS: A computerized literature search was carried out in the PubMed database, Embase, the Cochrane Library, Chinese BioMedical Literature on disc, Chinese Medical Current Contents, Chinese National Knowledge Infrastructure, Wanfang and VIP (Chinese Technological Journal of Database) to collect articles between June 1980 and December 2010 on therapy with immunosuppressants, e.g., glucorticosteroids, mycophenolate mofetil and leflunomide, combined with antivirals, e.g., interferon, lamivudine, entecavir and adefovir dipivoxil, in adult HBV-GN patients. The primary outcomes were remission of proteinuria, clearance of HBV e-antigen, and elevation of serum albumin. The secondary outcomes were blood levels of alanine aminotransferase, serum creatinine, and HBV-DNA titer. Meta-analysis was performed using Review Manager 5.1. Fixed or random effect models were employed to combine the results after a heterogeneity test. The effects of the combined therapy were analyzed for different doses of glucorticosteroid and different types of HBV-GN.

RESULTS: Twelve clinical trials with 317 patients were included. A significantly higher incidence of HBV-GN was found in male patients (relative risk = 2.40, 95% CI: 1.98-2.93). Combined therapy reduced the proteinuria significantly with a mean difference of 4.19 (95% CI: 3.86-4.53) and increased the serum albumin concentration significantly with a mean difference of -11.95 (95% CI: -12.97-10.93) without significant alterations of liver function (mean difference: 4.62, 95% CI: -2.55-11.79) and renal function (mean difference: 10.29, 95% CI: 0.14-20.45). No significant activation of HBV-DNA replication occurred (mean difference: 0.12, 95% CI: -0.37-0.62). There was no significant difference between the high dose glucorticosteroid group and the low dose glucorticosteroid group in terms of proteinuria remission (P = 0.76) and between different pathological types of HBV-GN [membranous glomerulonephritis (MN) vs mesangial proliferative glomerulonephritis, P = 0.68; MN vs membranoproliferative glomerulonephritis, P = 0.27].

CONCLUSION: Combined antiviral and immunosuppressant therapy can improve the proteinuria in HBV-GN patients without altering HBV replication or damaging liver and renal functions.

Keywords: Meta-analysis, Hepatitis B virus-associated glomerulonephritis, Glucocorticoids, Immunosuppressant, Antiviral drug