PT - JOURNAL ARTICLE AU - Jasvinder A. Singh AU - Alomgir Hossain AU - Ahmed Kotb AU - Ana Oliveira AU - Amy S. Mudano AU - Jennifer Grossman AU - Kevin Winthrop AU - George A. Wells TI - Treatments for Lupus Nephritis: A Systematic Review and Network Metaanalysis AID - 10.3899/jrheum.160041 DP - 2016 Oct 01 TA - The Journal of Rheumatology PG - 1801--1815 VI - 43 IP - 10 4099 - http://www.jrheum.org/content/43/10/1801.short 4100 - http://www.jrheum.org/content/43/10/1801.full SO - J Rheumatol2016 Oct 01; 43 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.