Adjuvant treatment with Yupingfeng formula for primary nephrotic syndrome in children A PRISMA systematic review and meta-analysis of randomized controlled trials

Background: Yupingfeng formula (YPFF) has been prescribed as adjuvant treatment for pediatric patients with primary nephrotic syndrome (PNS) in China for years. However, the efficacy and adverse effects of these formulations are controversial. A systematic review and meta-analysis of randomized controlled trials (RCTs) were performed to evaluate the benefits and harms of YPFF in treating PNS in children. Methods: The MEDLINE, EMBASE, Cochrane Library, CNKI, VIP, WanFang, and CBM databases were searched for RCTs comparing therapies with and without YPFF for PNS from inception to May 13, 2017. Relative risk (RR) and 95% confidence intervals (CI) were expressed for dichotomous outcomes, and weighted mean difference (WMD) with 95% CI for continuous outcomes. Cochrane collaboration tool was used to evaluate the risk of bias of methodologies. Results: Eight studies with 538 participants were identified. Treatment with YPFF significantly increased serum levels of IgA (WMD, 0.48, 95% CI, 0.40-0.56, P<.001), IgG (WMD, 3.36, 95% CI, 2.61-4.12, P<.001), CD4(+) T-lymphocytes (WMD, 3.35, 95% CI, 2.26-4.43, P<.001), but decreased the level of CD8(+) T-lymphocytes (WMD, -3.38, 95% CI -5.48 to -1.28, P=.002). YPFF also increased the rates of complete remission (RR: 1.35, 95% CI, 1.09-1.67, P=.005), and decreased the rates of relapse (RR: 0.57, 95% CI, 0.45-0.71, P<.001), and infection (RR: 0.72, 95% CI 0.62-0.83, P<.001). There was no significant difference in the level of IgM between the groups (WMD, 0.12, 95% CI -0.11-0.35, P=.322). Conclusions: YPFF could improve total remission rate and decrease the frequency of relapse and infection rate. The beneficial influence of YPFF may be associated with its immunomodulatory effects. More high-quality studies with larger sample sizes are needed to further identify its efficacy and safety.