RT Journal Article SR Electronic T1 Treatments for Lupus Nephritis: A Systematic Review and Network Metaanalysis JF The Journal of Rheumatology JO J Rheumatol FD The Journal of Rheumatology SP 1801 OP 1815 DO 10.3899/jrheum.160041 VO 43 IS 10 A1 Jasvinder A. Singh A1 Alomgir Hossain A1 Ahmed Kotb A1 Ana Oliveira A1 Amy S. Mudano A1 Jennifer Grossman A1 Kevin Winthrop A1 George A. Wells YR 2016 UL http://www.jrheum.org/content/43/10/1801.abstract AB Objective. To compare benefits and harms of lupus nephritis (LN) induction and maintenance treatments.Methods. We performed a systematic review and Bayesian network metaanalyses of randomized controlled trials (RCT) of immunosuppressive drugs or corticosteroids (CS) in LN. OR and 95% credible intervals (CrI) were calculated.Results. There were 65 RCT that met inclusion and exclusion criteria. Significantly lower risk of endstage renal disease (ESRD; 17 studies) was seen with cyclophosphamide (CYC; OR 0.49, 95% CrI 0.25–0.92) or CYC + azathioprine (AZA; OR 0.18, 95% CrI 0.05–0.57) compared with standard-dose CS, and with high-dose (HD) CYC (OR 0.16, 95% CrI 0.03–0.61) or CYC + AZA (OR 0.10, 95% CrI 0.03–0.34) compared with HD CS. HD CS was associated with higher risk of ESRD compared with CYC (OR 3.59, 95% CrI 1.30–9.86), AZA (OR 2.93, 95% CrI 1.08–8.10), or mycophenolate mofetil (MMF; OR 7.05, 95% CrI 1.66–31.91). Compared with CS, a significantly higher proportion of patients had renal response (14 studies) when treated with CYC (OR 1.98, 95% CrI 1.13–3.52), MMF (OR 2.42, 95% CrI 1.27–4.74), or tacrolimus (TAC; OR 4.20, 95% CrI 1.29–13.68). No differences were noted for the risk of malignancy (15 studies). The risk of herpes zoster (17 studies) was as follows: OR (95% CrI) MMF versus CS 4.38 (1.02–23.87), CYC versus CS 6.64 (1.97–25.71), TAC versus CS 9.11 (1.13–70.99), and CYC + AZA versus CS 8.46 (1.99–43.61).Conclusion. Renal benefits and the risk of herpes zoster were higher for immunosuppressive drugs versus CS. Data on relative and absolute differences are now available, which can be incorporated into patient-physician discussions related to systemic lupus erythematosus medication use.