Induction and maintenance therapy for lupus nephritis: a systematic review and meta-analysis

Abstract

The aim of this study was to assess the efficacies and toxicities of immunosuppressive treatments for lupus nephritis (LN) versus cyclophosphamide (CYC). A meta-analysis was performed to determine treatment efficacy and toxicity outcomes between mycophenolate mofetil (MMF) and CYC induction therapies, between MMF and azathioprine (AZA) as maintenance therapies, and between low-dose intravenous (IV) CYC and high-dose IV CYC therapy. Ten randomized controlled trials (RCTs) were included in the meta-analysis. In terms of induction therapies, MMF did not increase complete remission or partial remission rates as compared with CYC. However, the relative risks (RRs) of amenorrhea and leukopenia tended to be lower in the MMF group than in the CYC group. Meta-analysis of MMF versus AZA as a maintenance therapy showed no difference between the two groups in terms of response rates or the risk of developing end-stage renal disease. Low-dose IV CYC therapy had lower relapse rates than high-dose IV CYC therapy (RR 0.465, 95% confidence interval [CI] 0.261-0.830, p-value 0.010), and was associated with a lower infection risk (RR 0.688, 95% CI 0.523-0.905, p-value 0.008). In conclusion, MMF was found to be as effective as CYC and tended to have a better safety profile as an induction therapy for LN than CYC.

Updates on the Treatment of Lupus Nephritis

“…A number of meta-analyses unequivocally favor the additional benefit of using an immunosuppressive agent (or agents) during the maintenance phase of lupus nephritis therapy. 33,36,27 Given the risk for long-term toxicities with such agents, as well as their potential effect on fertility and risk for teratogenicity, the selection and dosage of maintenance therapy is an important and modifiable choice that doctor and patient should make together.…”

“…21 Several recent controlled trials, and subsequent meta-analyses, establish MMF as one of the recommended, first-choice regimens for inducing a remission in severe active proliferative lupus nephritis. [22][23][24][25][26][27] An initial report was a Chinese study of 42 patients randomized to receive either 12 months of oral MMF (2 g/d for 6 months followed by 1 g/d for 6 months) or 6 months of oral cyclophosphamide (2.5 mg/kg per day), followed by oral azathioprine (1.5 mg/kg per day) for 6 months. 22 Both groups received concomitant tapering doses of corticosteroids.…”

Management and Clinical Outcome of Systemic Lupus Erythematosus Patients; At Nephrology Unit , Zagazig University Hospitals: A One Year Study.

“…Serum creatinine, liver enzyme, TSH, serum bilirubin, SLE duration, SLEDAI-2k and FBS, But there was a significant difference among different groups regarding 24 hrs Urinary protein on admission being the highest in class (V-III/IV) (LN) and a significant difference regarding serum albumin being the lowest in class (V-III/IV) (LN) as illustrated in table (2).…”

Vilkliginio Nefrito Klinikinė-Patologinė Koreliacija

“…Tikslaus pacientų skaičiaus, turinčio inkstų pažeidimą, nėra, tačiau literatūros duomenimis, ~60 proc. pacientų SRV komplikuojasi vilkliginiu nefritu [9]. 50 proc.…”