Objective  To systematically review the efficacy of anti-inflammatory drugs in the treatment of diabetic nephropathy (DN).

Methods Databases including PubMed, The Cochrane Library, EMbase, Web of Science, Scopus, Ovid, ProQuest, CBM, CNKI, WanFang Data, VIP and Duxiu data were electronically searched to collect randomized controlled trials (RCTs) of anti-inflammatory drugs for DN from inception to April 5, 2022. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. RevMan 5.4 software were then used to perform Meta-analysis.

Results  A total of 29 literature and 26 RCTs involving 4 095 patients were included. The results of Meta- analysis showed that compared with conventional treatment, conventional treatment combined with anti- inflammatory drugs could effectively reduce urinary albumin to creatinine ratio [SMD=−0.17, 95%CI (−0.31, −0.03), P=0.02], urinary albumin excretion rate [SMD=−0.37, 95%CI (−0.56, −0.18), P=0.000 1], urinary protein excretion rate [SMD=−0.97, 95%CI (−1.29, −0.64), P=0.000  01], and glycosylated hemoglobin [SMD=−0.17, 95%CI (−0.27, −0.08), P=0.000  4], while there was no significant difference in reducing serum creatinine [SMD=−0.04, 95%CI (−0.19, 0.1), P=0.57], urea nitrogen [MD=−0.23, 95%CI (−0.50, 0.04), P=0.09] and fasting blood glucose [SMD=−0.15, 95%CI (−0.32, 0.02), P=0.08]. There was no statistically significant difference in changing glomerular filtration rate (GFR) [SMD=−0.04, 95%CI (−0.15, 0.07), P=0.47] with multiple drugs, except for a few drugs.

Conclusion Conventional treatment combined with anti-inflammatory drugs can better improve the level of proteinuria in patients with DN, but the improvement of renal function is not obvious. Due to the limitations of the number of included studies and the duration of treatment, the above conclusion needs to be verified by more high-quality studies.

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