Affiliation:
1. Pediatric resident, Isfahan University of Medical Sciences, Isfahan, Iran
2. Department of Pediatric Rheumatology,
Imam Hossein Children,s Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
Background:
Henoch-Schönlein purpura (IgA vasculitis) is the most common childhood
vasculitis, one of its complications is renal involvement. However, several treatment regimens
have been proposed to improve renal function in the long term, but which drug regimen can
be most effective is still controversial.
Methods:
This study was a systematic review. In order to find evidence related to the purpose of
this study, databases including Google Scholar, Web of Science, ProQuest and Medline via
PubMed, and Scopus were searched with the appropriate keywords. QUADAS-2 (a Quality Assessment
tools for Diagnostic Accuracy Studies) checklist was also used to evaluate the quality of
studies. Based on the keywords used in reviewing the information sources of scientific articles, in
the first stage, 86 studies were included in the review. Taking into account characteristics such as
lack of homogeneity with the objectives of the present study, finally, 11 studies were selected for
analysis and final evaluation.
Results:
A total of 11 studies, including 722 patients in the age range of 5.5 to 9.9 years with HSP
were included in the study. The follow-up period of the patients varied from 6 months to 16 years
in terms of examining the treatment process. In terms of study type, 7 studies were conducted as
prospective or retrospective (non-interventional) cohorts and 4 studies as randomized clinical trials.
The treatment regimen of injectable methylprednisolone followed by oral prednisolone resulted in
a long-term recovery of 79.2% (95% confidence interval between 0.66% and 88.2%); however, the
need for additional immunosuppressive in two studies was mentioned as 38% and 46.1%, respectively.
In the therapeutic regimen of oral methylprednisolone alone, a significant improvement in
long-term renal function was achieved in comparison with placebo. Administration of injectable
methylprednisolone followed by cyclosporine A had the highest effectiveness in terms of improving
renal function in the long term.
Conclusion:
Regimes based on the administration of prednisolone (either oral or injectable, either
as a single drug or as a combination) lead to long-term improvement of renal function in patients
with HSP, but the use of other immunosuppressive drugs such as cyclosporine A, of course, with
optimizing the drug dose can lead to a significant improvement in the clinical performance.
Funder
Isfahan University of Medical Sciences
Publisher
Bentham Science Publishers Ltd.