Induction and Maintenance Treatment of Lupus Nephritis: A Comprehensive Review of Meta-Analyses.
Authors
Park, Seoyeon
Jo, Yongsuk
Park, Seongeun
Oh, Jungmin
Kim, Hansol
An, Hyo Jin
Jeong, Gahee
Jung, Haerang
Lee, Hyun Jung
Nam, Seoung Wan
Hwang, Jimin
Tizaoui, Kalthoum
Publication Date
2022-01-11Journal Title
J Clin Med
ISSN
2077-0383
Publisher
MDPI AG
Volume
11
Issue
2
Language
en
Type
Article
This Version
VoR
Metadata
Show full item recordCitation
Shin, J. I., Li, H., Park, S., Yang, J. W., Lee, K. H., Jo, Y., Park, S., et al. (2022). Induction and Maintenance Treatment of Lupus Nephritis: A Comprehensive Review of Meta-Analyses.. J Clin Med, 11 (2) https://doi.org/10.3390/jcm11020343
Abstract
BACKGROUND: Lupus nephritis (LN) is present in over 50% of patients with systemic lupus erythematosus (SLE) which is managed with immunosuppressive and immunomodulatory therapies. However, several novel therapeutic approaches for LN are under investigation due to the adverse effects spectrum of conventional therapy; Methods: We performed a comprehensive review of meta-analyses aggregating the comparative efficacies of various pharmacotherapies for LN. We conducted a literature search and retrieved a total of 23 meta-analyses and network meta-analyses for summarization. Pharmacotherapies were evaluated across six major outcomes: remission, relapse, mortality, end stage kidney disease (ESKD) progression, infection, and malignancy. RESULT: Calcineurin inhibitors (CNI), particularly tacrolimus (TAC), in combination with glucocorticoids (GC) outperformed cyclophosphamide (CPA) with GC in the rate of remission, either complete or partial remission, and in terms of infectious complications. In maintenance therapy, MMF was superior to azathioprine (AZA) as the MMF-treated patients had lower relapse rate. INTERPRETATION: This review aggregates evidence of therapy for clinicians and sheds light on comparative efficacies of alternative LN treatments. As more promising agents are entering the market, such as voclosporin, belimumab, and obinutuzumab, LN management might undergo significant changes during the next years.
Keywords
systemic lupus erythematosus, lupus nephritis, end-stage kidney disease, calcineurin inhibitor, glucocorticoids
Identifiers
External DOI: https://doi.org/10.3390/jcm11020343
This record's URL: https://www.repository.cam.ac.uk/handle/1810/333020
Rights
Licence:
https://creativecommons.org/licenses/by/4.0/
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