The Effectiveness and Safety of Abelmoschus manihot in Treating IgA Nephropathy: A Systematic Review and Meta-Analysis

INTRODUCTION: IgA nephropathy (IgAN) is a common issue. In China, Abelmoschus manihot (AM) is widely used in the treatment of IgAN. However, their combined effectiveness and safety for this purpose have not yet been explored. AM is an effective medicine for treating IgAN. This meta-analysis aimed to evaluate the effectiveness of AM for IgAN. MATERIALS AND METHODS: The Cochrane Library, PubMed, EMBASE, Allied and Complementary Medicine Database (AMED), Chinese Biomedical Literature Database (CBM), Chinese National Knowledge Infrastructure Database (CNKI), Chinese Science and Technique Journals Database (VIP), and the Wanfang Database were searched from their inceptions to June 2021. Random clinical trials (RCTs) comparing the effects of AM treatment in patients with IgAN were included. The study evaluated the efficacy or effectiveness of AM for IgAN and had clear outcome data, such as total effectiveness rate or proteinuria. RESULTS: A total of 11 RCTs with 850 participants were included in this meta-analysis. The results of the meta-analysis showed that, compared with that of the conventional therapy alone, being combined with conventional treatment was significantly more effective for the total efficacy rate (OR = 4.33; 95% CI = 2.66, 7.04; P < 0.00001) and proteinuria (MD = −0.41 g/24 h; 95% CI = −0.44, −0.38; P < 0.00001) but had no effect on serum creatinine (Scr) (MD = −2.23 μmol/L; 95% CI = −5.90, 1.45; P=0.24), eGFR (MD = −0.45 mL/min·1.73 m2; 95% CI = −1.24, 2.13; P=0.60), Bun (MD = −0.22 mmol/L; 95% CI = −0.59, 0.14; P=0.23), systolic blood pressure (MD = −0.04 mmHg; 95% CI = −2.59, 2.51; P=0.98), diastolic blood pressure (MD = −0.34 mmHg, 95% CI = −1.65, 2.33; P=0.74), systolic blood pressure (MD = −0.04 mmHg, 95% CI = −2.59, 2.51; P=0.98), or serum albumin (MD = 1.70 g/L, 95% CI = −1.06, 4.45; P=0.23). CONCLUSIONS: AM provided additional benefits to proteinuria individuals with IgAN. However, due to the high clinical heterogeneity and small sample size of the included trials, future studies should conduct more rigorous RCTs on the clinical efficacy and safety of AM and RCTs with a larger sample size involving multicenters.