Network meta-analysis of best treatment strategies for adult Chinese patients with idiopathic membranous nephropathy combined with nephrotic syndrome

The current study aimed to evaluate the best treatment strategies for adult Chinese patients with idiopathic membranous nephropathy (IMN) combined with nephrotic syndrome (NS) using network meta-analysis. Pubmed, Embase, Cochrane Library, MEDLINE, CNKI, CBM, and Wanfang databases were searched for clinical randomized controlled trials in adult Chinese patients with IMN combined with NS. R 3.03, Stata 14.0, and ADDIS software were used for statistical analysis of data. Thirty-six clinical randomized controlled trials, including 2,481 patients with IMN combined with NS and 16 types of clinical treatment, were studied. There was good convergence and no statistical differences, according to inconsistency testing (P > 0.05). Surface under the cumulative ranking curve (SUCRA) ranking of predicted efficacy for therapeutic measures revealed the following: (1) Induced remission (complete remission+partial remission) was the primary endpoint of efficacy; (2) Relapse after remission was a secondary endpoint of efficacy; and (3) Cluster analysis for comprehensive evaluation of remission and relapse rates revealed that mycophenolic mofetil+prednisone+T. wilfordii led to the highest remission rate and lowest recurrence rate, while FK506 monotherapy or cyclosporine combined with prednisone had relatively poor efficacy. In adult Chinese patients with IMN combined with NS, mycophenolic mofetil combined with prednisone and T. wilfordii is appropriate as a first-line treatment program. Moreover, glucocorticoids combined with tacrolimus can serve as a substitute treatment program. Multi-target treatment with T. wilfordii and other immunosuppressants can increase efficacy.