{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T14:46:07Z","timestamp":1786373167424,"version":"build-2736575974"},"reference-count":44,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2013,5]]},"abstract":"Summary<\/jats:title>\n \n Background and objectives<\/jats:title>\n The efficacy and safety of immunosuppression for idiopathic membranous nephropathy (IMN) with nephrotic syndrome are still controversial. A systematic review and meta-analysis of randomized controlled trials (RCTs) was performed.<\/jats:p>\n <\/jats:sec>\n \n Design, setting, participants, & measurements<\/jats:title>\n The Cochrane Library, PUBMED, EMBASE, Chinese Database, and Clinical Trial Registries (June 2012) were searched to identify RCTs investigating the effect of immunosuppression on adults with IMN and nephrotic syndrome.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n This review was an update (36 RCTs, 1762 participants) of the 2004 version (18 RCTs, 1025 participants). Immunosuppression significantly reduced all-cause mortality or ESRD (15 RCTs, 791 participants; risk ratio, 0.58 [95% confidence interval, 0.36\u20130.95];\n P<\/jats:italic>\n =0.03). However, the result was not consistent when prespecified subgroup analyses were undertaken. Immunosuppression increased complete or partial remission (CR + PR) (16 RCTs, 864 participants; 1.31 [1.01\u20131.70];\n P<\/jats:italic>\n =0.04) but resulted in more withdrawals or hospitalizations (16 RCTs, 880 participants; 5.35 [2.19\u201313.02];\n P<\/jats:italic>\n =0.002). Corticosteroids combined with alkylating agents significantly reduced all-cause mortality or ESRD (8 RCTs, 448 participants; 0.44 [0.26\u20130.75];\n P<\/jats:italic>\n =0.002) and increased CR + PR (7 RCTs, 422 participants; 1.46 [1.13\u20131.89];\n P<\/jats:italic>\n =0.004) but led to more adverse events (4 RCTs, 303 participants; 4.20 [1.15\u201315.32];\n P<\/jats:italic>\n =0.03). Cyclophosphamide was safer than chlorambucil (3 RCTs, 147 participants; 0.48 [0.26\u20130.90];\n P<\/jats:italic>\n =0.02). Cyclosporine and mycophenolate mofetil failed to show superiority over alkylating agents. Tacrolimus and adrenocorticotropic hormone significantly reduced proteinuria.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Alkylating agents plus corticosteroids had long-term and short-term benefits for adult IMN, but resulted in more withdrawals or hospitalizations.<\/jats:p>\n <\/jats:sec>","DOI":"10.2215\/cjn.07570712","type":"journal-article","created":{"date-parts":[[2013,3,1]],"date-time":"2013-03-01T10:04:57Z","timestamp":1362132297000},"page":"787-796","source":"Crossref","is-referenced-by-count":50,"title":["Immunosuppression for Membranous Nephropathy"],"prefix":"10.2215","volume":"8","author":[{"given":"Yizhi","family":"Chen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arrigo","family":"Schieppati","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guangyan","family":"Cai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiangmei","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier","family":"Zamora","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni A.","family":"Giuliano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norbert","family":"Braun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annalisa","family":"Perna","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-14-20230811","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1093\/ndt\/gfr371","article-title":"Management of patients with membranous nephropathy.","volume":"27","author":"Hofstra","year":"2012","journal-title":"Nephrol Dial Transplant"},{"key":"R2-14-20230811","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1038\/nrneph.2009.101","article-title":"Controversies in the treatment of idiopathic membranous nephropathy.","volume":"5","author":"Waldman","year":"2009","journal-title":"Nat Rev Nephrol"},{"key":"R3-14-20230811","doi-asserted-by":"crossref","first-page":"2163","DOI":"10.1517\/14656566.2010.494599","article-title":"Management of idiopathic membranous nephropathy.","volume":"11","author":"Ponticelli","year":"2010","journal-title":"Expert Opin Pharmacother"},{"key":"R4-14-20230811","doi-asserted-by":"crossref","first-page":"1760","DOI":"10.1093\/ndt\/gfq017","article-title":"Alkylating agents in membranous nephropathy: Efficacy proven beyond doubt.","volume":"25","author":"Hofstra","year":"2010","journal-title":"Nephrol Dial Transplant"},{"key":"R5-14-20230811","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1093\/ndt\/9.5.469","article-title":"Treatment of membranous nephropathy: A meta-analysis.","volume":"9","author":"Couchoud","year":"1994","journal-title":"Nephrol Dial Transplant"},{"key":"R6-14-20230811","doi-asserted-by":"crossref","first-page":"862","DOI":"10.1016\/0272-6386(95)90568-5","article-title":"A review of therapeutic studies of idiopathic membranous glomerulopathy.","volume":"25","author":"Hogan","year":"1995","journal-title":"Am J Kidney Dis"},{"key":"R7-14-20230811","doi-asserted-by":"crossref","first-page":"1553","DOI":"10.1681\/ASN.V581553","article-title":"Are cytotoxic agents beneficial in idiopathic membranous nephropathy? 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