Abstract
PV131 / #261
Poster Topic: AS15 - Lupus Nephritis-Clinical
Background/Purpose This study aims to evaluate the comparative efficacy and safety of various initial treatments for lupus nephritis through a systematic review and network meta-analysis.
Methods A comprehensive literature search was conducted across MEDLINE, EMBASE, Cochrane Library, and LILACS from inception to June 2024 in order to identify randomized controlled trials (RCTs) comparing initial treatments for lupus nephritis. Two reviewers independently performed data extraction and assessed the risk of bias. A frequentist random-effects network meta-analysis was conducted using the restricted maximum likelihood (REML) method to estimate heterogeneity. The certainty of evidence was evaluated using the GRADE approach.
Results We included 38 RCTs encompassing 5,146 participants and 11 interventions. Mycophenolate mofetil was selected as the common comparator. The network meta-analysis revealed that voclosporin combined with Mycophenolate mofetil (RR 1.9 95% CI 1.47 to 2.47, RD 281.4, 95% CI 146.3 to 465.4; high certainty) and belimumab combined with Mycophenolate mofetil (RR 1.47, 95% CI 1.23 to 1.74, RD 145, 95% CI 72.7 to 230.9; high certainty) increased complete renal response compared to Mycophenolate mofetil alone. Tacrolimus combined with Mycophenolate mofetil (RR 1.24 95% CI 1.05 to 1.46, RD 113.7, 95% CI 25.2 to 217.7; low certainty) and Obinutuzumab combined with Mycophenolate mofetil (RR 1.57 95% CI 1.05 to 2.34, RD 270.4, 95% CI 22.7 to 640.5; low certainty) also showed potential benefits but with low certainty evidence. Cyclophosphamide was possibly associated with a small decrease in complete renal response compared to Mycophenolate mofetil (RR 0.90, 95% CI 0.77 to 1.04; low certainty). However, the effects of the assessed interventions on mortality and renal replacement therapy outcomes were highly uncertain.
Conclusions Combination therapies, particularly voclosporin or belimumab with Mycophenolate mofetil, may provide enhanced outcomes for lupus nephritis initial treatment. Given the complexity of lupus nephritis, clinicians should weigh these findings alongside considerations such as drug availability, cost, and individual patient preferences to guide treatment decisions.
- Copyright © 2025 by the Journal of Rheumatology
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