Is mycophenolate mofetil superior to pulse intravenous cyclophosphamide for induction therapy of proliferative lupus nephritis in Egyptian patients?

El-Shafey, Eid M; Abdou, Said; Shareef, Mohamed

doi:10.1007/s10157-010-0270-7

Cited by 42 publications

(23 citation statements)

References 28 publications

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“…Benefits were assessed by two composite outcomes (for detailed definitions of components, see Additional file 1 ): (1) renal remission/response (indicating success of therapy): included complete renal remission, [ 17 ] partial renal remission [ 18 , 19 ] and renal response; (2) renal relapse/flare (indicating failure of therapy): included renal relapse [ 20 ] and renal flare (Additional file 1 ). Harms were assessed by two composite outcomes: (1) ovarian failure/amenorrhea: included ovarian failure and amenorrhea; and (2) bone marrow toxicity: cytopenia including leucopenia.…”

Section: Methodsmentioning

confidence: 99%

Comparative effectiveness of immunosuppressive drugs and corticosteroids for lupus nephritis: a systematic review and network meta-analysis

et al. 2016

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BackgroundThere is a lack of high-quality meta-analyses and network meta-analyses of immunosuppressive drugs for lupus nephritis. Our objective was to assess the comparative benefits and harms of immunosuppressive drugs and corticosteroids in lupus nephritis.MethodsWe conducted a systematic review and network meta-analysis (NMA) of trials of immunosuppressive drugs and corticosteroids in patients with lupus nephritis. We calculated odds ratios (OR) and 95 % credible intervals (CrI).ResultsSixty-five studies that met inclusion and exclusion criteria; data were analyzed for renal remission/response (37 trials; 2697 patients), renal relapse/flare (13 studies; 1108 patients), amenorrhea/ovarian failure (eight trials; 839 patients) and cytopenia (16 trials; 2257 patients). Cyclophosphamide [CYC] low dose (LD) and CYC high-dose (HD) were less likely than mycophenolate mofetil [MMF] and azathioprine [AZA], CYC LD, CYC HD and plasmapharesis less likely than cyclosporine [CSA] to achieve renal remission/response. Tacrolimus [TAC] was more likely than CYC LD to achieve renal remission/response. MMF and CYC were associated with a lower odds of renal relapse/flare compared to PRED and MMF was associated with a lower rate of renal relapse/flare than AZA. CYC was more likely than MMF and PRED to be associated with amenorrhea/ovarian failure. Compared to MMF, CYC, AZA, CYC LD, and CYC HD were associated with a higher risk of cytopenia.ConclusionsIn this systematic review and NMA, we found important differences between immunosuppressives used for the treatment of lupus nephritis. Patients and physicians can use this information for detailed informed consent in a patient-centered approach. Study limitations of between-study clinical heterogeneity and small sample size with type II error must be considered when interpreting these findings.Systematic review registrationPROSPERO: CRD42016032965Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-016-0328-z) contains supplementary material, which is available to authorized users.

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Section: Methodsmentioning

confidence: 99%

Comparative effectiveness of immunosuppressive drugs and corticosteroids for lupus nephritis: a systematic review and network meta-analysis

et al. 2016

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“…To date, at least 8 randomized controlled trials have compared MF with CYC administered to induce remission in LN [7]. In several, MF was similar [13,14,15] to or even more efficacious [16,17,18] than CYC (achieving remission in 53–80% of patients). Indeed, in the largest trial performed to date, remissions at 6 months occurred in a similar percentage of patients in both arms (MF 56.2% vs. CYC 53%) [10].…”

Section: Discussionmentioning

confidence: 99%

Mycophenolate as Induction Therapy in Lupus Nephritis with Renal Function Impairment

Rivera

Fulladosa²,

Poveda³

et al. 2012

Am J Nephrol

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Background: Mycophenolate (MF) is effective as induction therapy for lupus nephritis (LN) in patients with normal renal function; however, little is known about its role in patients with impaired renal failure. The purpose of this study was to evaluate the response to MF in LN and its association with baseline renal function. Methods: Data were obtained for 90 patients from 12 Spanish renal units who were receiving MF as induction therapy for LN. Patients were classified into 2 groups: group 1 (estimated glomerular filtration rate [eGFR] ≥60 ml/min/1.73 m²) and group 2 (eGFR <60 ml/min/ 1.73 m²). The primary outcome measure was the percentage of patients who achieved any response and its relationship with initial eGFR. The secondary outcome measures were the percentage of patients who achieved a complete response (CR) or partial response (PR) and the appearance of relapses during treatment and side effects. Results: At initiation of MF treatment, there were no differences in the main parameters between group 1 (n = 63; eGFR 87 ± 23 ml/min/ 1.73 m²) and group 2 (n = 27; eGFR 44 ± 12 ml/min/1.73 m²). Exposure to prednisone and MF was similar. The percentages of patients who achieved a response in groups 1 and 2 were, respectively, 69.2 and 43.8% at 6 months and 81.3 and 73.7% at 12 months. CR was more frequent in group 1, whereas PR was similar in both groups. Four patients relapsed and side effects were unremarkable. Conclusions: MF is effective and safe as induction therapy for LN, and response is even achieved in patients with baseline renal impairment.

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“…From 2012 onward, a range of other immunomodulatory drugs including atacicept, abatacept, laquinimod, sirukumab, and mizoribine have been evaluated as induction therapies. Twenty-one induction therapy trials (905 participants) evaluated IV cyclophosphamide (500-1,000 mg/m 2 body surface area monthly), 19,21,23,25,29,32,37,42,43,[48][49][50]52,56,57,[63][64][65][66][67]69 10 trials (516 participants) evaluated MMF (2,000-3,000 mg daily), 21,31,42,43,47,56,61,63,65,66 6 trials (123 participants) evaluated oral cyclophosphamide (1.5-4 mg/kg daily), 23,31,39,41,44,58 Figure 1. Summary of evidence search and selection.…”

Section: Description Of Included Studiesmentioning

confidence: 99%

Induction and Maintenance Immunosuppression Treatment of Proliferative Lupus Nephritis: A Network Meta-analysis of Randomized Trials

Palmer

Tunnicliffe

Singh‐Grewal

et al. 2017

American Journal of Kidney Diseases

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Evidence for induction therapy for lupus nephritis is inconclusive based on treatment effects on all-cause mortality, doubling of serum creatinine level, and end-stage kidney disease. MMF, calcineurin inhibitors, or their combination were most effective for inducing remission compared to IV cyclophosphamide, while conferring similar or lower treatment toxicity. MMF was the most effective maintenance therapy.

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Is mycophenolate mofetil superior to pulse intravenous cyclophosphamide for induction therapy of proliferative lupus nephritis in Egyptian patients?

Abstract: In this 24-week trial, MMF or IVC combined with corticosteroids demonstrated equal efficacy in inducing remission of proliferative lupus nephritis.

Cited by 42 publications

References 28 publications

Comparative effectiveness of immunosuppressive drugs and corticosteroids for lupus nephritis: a systematic review and network meta-analysis

Comparative effectiveness of immunosuppressive drugs and corticosteroids for lupus nephritis: a systematic review and network meta-analysis

Mycophenolate as Induction Therapy in Lupus Nephritis with Renal Function Impairment

Induction and Maintenance Immunosuppression Treatment of Proliferative Lupus Nephritis: A Network Meta-analysis of Randomized Trials

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