RT Journal Article
SR Electronic
T1 Immunosuppressive Therapies for the Induction Treatment of Proliferative Lupus Nephritis: A Systematic Review and Network Metaanalysis
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP 1998
OP 2007
DO 10.3899/jrheum.140050
VO 41
IS 10
A1 Tian, Simon Yu
A1 Feldman, Brian M.
A1 Beyene, Joseph
A1 Brown, Patrick E.
A1 Uleryk, Elizabeth M.
A1 Silverman, Earl D.
YR 2014
UL http://www.jrheum.org/content/41/10/1998.abstract
AB Objective. To evaluate and determine the most effective immunosuppressive therapy for the induction treatment of proliferative lupus nephritis (PLN) based on renal remission. Methods. A systematic review of randomized controlled trials was conducted. The outcomes were renal remission at 6 months: (1) normalization of serum creatinine [(sCr), or within 15% of the normal range, i.e., sCr < 132 µmol/l — creatinine remission]; and (2) proteinuric remission (prU < 0.5 g/day/1.73m2). A Bayesian network metaanalysis was used. Results. The OR (95% credible interval) of inducing an sCr remission at 6 months was 1.70 (0.51, 6.87) for mycophenolate mofetil (MMF) versus cyclophosphamide (CYC); 2.16 (0.38, 13.36) for tacrolimus (Tac) versus CYC; and 1.25 (0.13, 10.51) for Tac versus MMF. For proteinuric remission the OR was 1.46 (0.81, 3.04) for MMF versus CYC; 1.96 (0.80, 5.11) for Tac versus CYC; and 1.34 (0.43, 3.90) for Tac versus MMF. The probability (95% credible interval) of inducing a creatinine remission at 6 months was Tac 56% (19%, 88%); MMF 51% (23%, 79%); and CYC 37% (28%, 47%). The probability of inducing a proteinuric remission was Tac 41% (23%, 63%); MMF 34% (23%, 50%); CYC 26% (20%, 32%); azathioprine 10% (1%, 55%); prednisone 11% (2%, 38%). None of the results were conclusive when examined in a sensitivity analysis. Conclusion. There is currently insufficient evidence to determine which of these immunosuppressive agents is superior. The probability of renal remission is 50% or lower at 6 months.