SYSTEMATIC REVIEW article
Front. Nephrol.
Sec. Glomerular disease
Volume 5 - 2025 | doi: 10.3389/fneph.2025.1591939
Efficacy and Safety of Glucocorticoids Combined with Immunosuppressants in the Treatment of Idiopathic Membranous Nephropathy: A Network Meta-Analysis of Randomized Controlled Trials
Provisionally accepted
- 1Shanxi Provincial People's Hospital, Taiyuan, China
- 2Department of Orthopaedics, Shanxi Bethune Hospital (Shanxi Academy of Medical Sciences), the Third Hospital of Shanxi Medical University; Tongji Shanxi Hospital, Taiyuan, China
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Background: Idiopathic membranous nephropathy (IMN) is a principal cause of adult-onset nephrotic syndrome and frequently progresses to end-stage renal disease (ESRD). This network meta-analysis evaluated the efficacy and safety of glucocorticoids (GCs) combined with immunosuppressants in the treatment of IMN.Methods: A systematic review and network meta-analysis of 32 randomized controlled trials (RCTs) was conducted according to PRISMA guidelines. PubMed, Embase, Web of Science, and CNKI were searched up to October 3, 2024. Effect sizes were expressed as standardized mean differences (SMD) and odds ratios (OR) with 95% confidence intervals (CIs). Primary outcomes included 24-hour urinary total protein (24hUTP), serum creatinine (SCr), remission rates, relapse, and adverse events.Results: Thirty-two RCTs with 1814 patients were included. GCs combined with tacrolimus (GCs + TAC) showed the highest efficacy in reducing 24hUTP (SMD = -1.75, 95% CI: -3.00 to -0.50), followed by GCs + cyclophosphamide (GCs + CYC, SMD = -1.57, 95% CI: -2.91 to -0.24). GCs + cyclosporine (GCs + CsA) showed the best results for reducing SCr (SMD = -1.55, 95% CI: -3.08 to -0.03), while GCs + rituximab (GCs + RTX) also preserved renal function (SMD = -2.07, 95% CI: -4.00 to -0.14). GCs + TAC was most effective in achieving complete remission (OR = 3.87, 95% CI: 1.36 to 10.99), while GCs + mycophenolate mofetil (GCs + MMF) ranked highest for partial remission. No significant differences in adverse events were observed across treatments.GCs + TAC and GCs + CYC are most effective for proteinuria reduction and remission, while GCs + CsA and GCs + RTX offer better renal protection. These findings help optimize IMN treatment strategies.
Keywords: Idiopathic membranous nephropathy, Glucocorticoids, Immunosuppressants, Network meta-analysis, RTX
Received: 12 May 2025; Accepted: 14 Aug 2025.
Copyright: © 2025 Zhang, Zhao and Li. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Rong shan Li, Shanxi Provincial People's Hospital, Taiyuan, China
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