Meta-analysis: anti-viral therapy of hepatitis B virus-associated glomerulonephritis

Authors


Dr F. Fabrizi, Divisione di Nefrologia e Dialisi, Ospedale Maggiore, IRCCS, Pad. Croff, Via Commenda 15, Milan, 20122, Italy.
E-mail: fabrizi@policlinico.mi.it

Abstract

Summary

Background

Hepatitis B virus-associated glomerulonephritis is an infrequent complication of chronic hepatitis B virus (HBV) with significant morbidity. A causal association between hepatitis B virus infection and the development of glomerulonephritis remains controversial. Also, the optimal therapy is undefined although several approaches have been made.

Aim

To evaluate the efficacy and safety of anti-viral therapy (interferon or lamivudine) in HBV-associated glomerulonephritis by a systematic review and meta-analysis of clinical trials.

Methods

The primary outcome was clinical response (as a measure of efficacy); the secondary outcomes were drop-out rate (as a measure of tolerability), and virological response. We used the random effects model of DerSimonian and Laird, with heterogeneity, sensitivity and meta-regression analyses.

Results

We identified six clinical trials (84 unique patients); three had controlled design. The overall estimate for proteinuria remission was 65.2% (95% confidence intervals: 52.7–75.9%), Q-test for heterogeneity = 7.731, P = 0.172, I2 = 35.327. The overall estimate for hepatitis B e antigen clearance was 62.0% (95% confidence intervals: 50.5–72.2%). The overall estimate for drop-out rate was 12.7% (95% confidence intervals: 6.4–23.6%). Meta-regression analysis showed a significant link between hepatitis B e antigen clearance and logit rate of proteinuria remission after interferon therapy [coefficient –2.585 (S.E. 1.089), P = 0.017].

Conclusion

Remission of the nephrotic syndrome is accompanied by clearance of HBV replication, supporting the role of the virus in the pathogenesis of the disease.

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