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Meta-analysis: anti-viral therapy of hepatitis B virus-associated glomerulonephritis Fabrizi F; Dixit V; Martin PAliment Pharmacol Ther 2006[Sep]; 24 (5): 781-8BACKGROUND: 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.|Anti-HIV Agents/therapeutic use[MESH]|Antiviral Agents/*therapeutic use[MESH]|Clinical Trials as Topic[MESH]|Female[MESH]|Glomerulonephritis/*drug therapy/virology[MESH]|Hepatitis B Antigens/analysis[MESH]|Hepatitis B, Chronic/*complications/drug therapy[MESH]|Humans[MESH]|Interferons/*therapeutic use[MESH]|Lamivudine/*therapeutic use[MESH]|Male[MESH]|Nephrotic Syndrome/drug therapy/virology[MESH]|Patient Dropouts[MESH]|Treatment Outcome[MESH] |
