META-ANALYSIS OF IMMUNOSUPPRESSIVE THERAPY OUTCOMES IN ATHLETES WITH MEMBRANOUS NEPHROPATHY: EFFICACY AND SAFETY ASSESSMENT

Abstract

Objective: To evaluate the efficacy and safety of various immunosuppressive regimens specifically in athletes diagnosed with idiopathic membranous nephropathy (IMN), utilizing a reticular meta-analysis approach. Methods: We conducted a comprehensive search of databases including Cochrane Library, PubMed, Medline, ClinicalTrials.gov, Wanfang, and VP journal, up until February 30, 2021. The search focused on randomized controlled trials involving athletes, aiming to compare different immunosuppressive treatments directly and indirectly. Results: A total of 51 randomized controlled trials involving 2,955 athlete cases were analyzed. Seventeen immunosuppressive protocols were evaluated using a probability cumulative ranked area map. In terms of overall response rate, the regimen based on glucocorticoids ranked as follows: Triptotrimodoside > Triptodoside > Imidazolbin > Triptolide trimodoside with Tacrolimus > Rituximab. For reducing 24-hour urinary protein quantification, the top regimen was Triptolidside, followed by Tripterygodoside combined with Tacrolimus. In maintaining serum creatinine levels, Tripterygium Tripterygoside combined with Micoxol was optimal, followed by Triptolide with Leflunomide. Regarding tolerance, Tripteridyide showed the best profile, followed by Tacrolimus and Tripterygodoside combined with Leflunomide. Conclusion: While certain immunosuppressive regimens showed promising outcomes in terms of response rate, protein reduction, and creatinine maintenance for athletes with IMN, there remains a need for more high-quality, athlete-specific randomized trials to establish definitive recommendations for treatment efficacy and safety.