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Meta‐analysis: anti‐viral therapy of hepatitis B virus‐associated glomerulonephritis
Author(s) -
FABRIZI F.,
DIXIT V.,
MARTIN P.
Publication year - 2006
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/j.1365-2036.2006.03041.x
Subject(s) - medicine , hepatitis b virus , lamivudine , confidence interval , hepatitis b , gastroenterology , immunology , meta analysis , proteinuria , glomerulonephritis , virus , kidney
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, I 2 = 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.