Treatments for Lupus Nephritis: A Systematic Review and Network Metaanalysis

@article{Singh2016TreatmentsFL,
  title={Treatments for Lupus Nephritis: A Systematic Review and Network Metaanalysis},
  author={Jasvinder A. Singh and Alomgir Hossain and Ahmed R. Kotb and Ana Oliveira and Amy Mudano and Jennifer M. Grossman and Kevin L. Winthrop and George A Wells},
  journal={The Journal of Rheumatology},
  year={2016},
  volume={43},
  pages={1801 - 1815}
}
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… 

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References

SHOWING 1-10 OF 129 REFERENCES

Immunosuppressive Therapies for the Induction Treatment of Proliferative Lupus Nephritis: A Systematic Review and Network Metaanalysis

TLDR
There is currently insufficient evidence to determine which of these immunosuppressive agents is superior, but the probability of renal remission is 50% or lower at 6 months.

Immunosuppressive Therapies for the Maintenance Treatment of Proliferative Lupus Nephritis: A Systematic Review and Network Metaanalysis

TLDR
Although the data suggest that MMF may be superior to other treatments for the maintenance treatment of PLN, the evidence is not conclusive and there was no evidence of benefit for 1 therapy over another.

Azathioprine/methylprednisolone versus cyclophosphamide in proliferative lupus nephritis. A randomized controlled trial.

TLDR
In this open-label randomized controlled trial, cyclophosphamide was superior to azathioprine with regard to renal relapses and HZV and Parameters for ovarian function did not differ between the two groups.

Influence of race/ethnicity on response to lupus nephritis treatment: the ALMS study

TLDR
MMF and IVC have similar efficacy overall to short-term induction therapy for LN, however, race, ethnicity and geographical region may affect treatment response; more Black and Hispanic patients responded to MMF than IVC.

Treatment of diffuse proliferative lupus glomerulonephritis: a comparison of two cyclophosphamide-containing regimens.

  • C. MokC. Ho T. Au
  • Medicine
    American journal of kidney diseases : the official journal of the National Kidney Foundation
  • 2001
TLDR
It is concluded that sequential oral immunosuppression with CYC and AZA tended to have better efficacy than IV pulse CYC in the treatment of lupus DPGN but was associated with more toxicities.

A randomized pilot trial comparing cyclosporine and azathioprine for maintenance therapy in diffuse lupus nephritis over four years.

TLDR
For patients with diffuse proliferative lupus nephritis, azathioprine or cyclosporine combined with corticosteroids demonstrated equal efficacy in the prevention of flares.

Randomized, controlled trial of prednisone, cyclophosphamide, and cyclosporine in lupus membranous nephropathy.

TLDR
Patients with lupus membranous nephropathy are at substantial long-term risk for morbidity and mortality associated with protracted nephrotic syndrome, including ESRD and regimens containing CsA or IVCY are each more effective than prednisone alone in inducing remission of proteinuria among patients with LMN.

Mycophenolate mofetil or intravenous cyclophosphamide for lupus nephritis with poor kidney function: a subgroup analysis of the Aspreva Lupus Management Study.

TLDR
A post hoc subgroup analysis of patients with low estimated glomerular filtration rates from a large trial of MMF compared to cyclophosphamide in lupus nephritis did not detect a difference in the primary outcome of response, however, MMF may result in quicker recovery of kidney function compared with those treated with cycloph phosphamide.

Mycophenolate mofetil or tacrolimus compared with intravenous cyclophosphamide in the induction treatment for active lupus nephritis.

  • Xiao LiH. Ren N. Chen
  • Medicine
    Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
  • 2012
TLDR
This pilot study suggests that both MMF and tacrolimus are possible alternatives to IVC as induction therapies for ALN in Chinese patients and possibly results in a faster resolution of proteinuria and hypoalbuminemia.

Short-term outcomes of induction therapy with tacrolimus versus cyclophosphamide for active lupus nephritis: A multicenter randomized clinical trial.

  • Wei ChenXueqing Tang Xueqing Yu
  • Medicine
    American journal of kidney diseases : the official journal of the National Kidney Foundation
  • 2011
TLDR
In conjunction withprednisone, induction therapy with tacrolimus is at least as efficacious as intravenous cyclophosphamide and prednisone in producing complete remission of lupus nephritis and has a more favorable safety profile.
...