AIM: The options for long-term maintenance therapy in lupus nephritis (LN) remain controversial. This meta-analysis of randomized controlled trials (RCTs) assessed the prognosis and safety of mycophenolate mofetil (MMF) versus azathioprine (AZA) used as maintenance therapy for lupus nephritis. METHODS: The data of Cochrane Library, PubMed, EMBASE were retrieved to search the studies about the RCT studies that compared MMF with AZA used as maintenance therapy for lupus nephritis. We extracted the data reflecting prognosis, which included mortality, end-stage renal failure (ESRF), renal relapse, doubling serum creatinine, and adverse effects, then further analyzed the combined results of data and calculated the relative risk (RR). RESULTS: Four RCT studies including 328 patients were enrolled into our meta-analysis. There was no difference between the patients receiving either MMF or AZA for maintenance therapy in preventing relapse, progression to end-stage renal failure, death and doubling of serum creatinine. MMF is not superior to AZA in terms of the risks of infection and gastrointestinal upset, but fewer patients receiving MMF developed leukopenia (RR 0.12; 95% confidence interval (CI), 0.04-0.39; P = 0.0004) and amenorrhoea (RR 0.17; 95% CI, 0.04-0.72; P = 0.02) than those receiving AZA. CONCLUSION: The current limited evidence suggests that MMF offers similar prognosis as AZA for maintenance therapy, while MMF appears safer than AZA in the treatment of lupus nephritis.
AIM: The options for long-term maintenance therapy in lupus nephritis (LN) remain controversial. This meta-analysis of randomized controlled trials (RCTs) assessed the prognosis and safety of mycophenolate mofetil (MMF) versus azathioprine (AZA) used as maintenance therapy for lupus nephritis. METHODS: The data of Cochrane Library, PubMed, EMBASE were retrieved to search the studies about the RCT studies that compared MMF with AZA used as maintenance therapy for lupus nephritis. We extracted the data reflecting prognosis, which included mortality, end-stage renal failure (ESRF), renal relapse, doubling serum creatinine, and adverse effects, then further analyzed the combined results of data and calculated the relative risk (RR). RESULTS: Four RCT studies including 328 patients were enrolled into our meta-analysis. There was no difference between the patients receiving either MMF or AZA for maintenance therapy in preventing relapse, progression to end-stage renal failure, death and doubling of serum creatinine. MMF is not superior to AZA in terms of the risks of infection and gastrointestinal upset, but fewer patients receiving MMF developed leukopenia (RR 0.12; 95% confidence interval (CI), 0.04-0.39; P = 0.0004) and amenorrhoea (RR 0.17; 95% CI, 0.04-0.72; P = 0.02) than those receiving AZA. CONCLUSION: The current limited evidence suggests that MMF offers similar prognosis as AZA for maintenance therapy, while MMF appears safer than AZA in the treatment of lupus nephritis.
Authors: Candace H Feldman; Francisco M Marty; Wolfgang C Winkelmayer; Hongshu Guan; Jessica M Franklin; Daniel H Solomon; Karen H Costenbader; Seoyoung C Kim Journal: Arthritis Rheumatol Date: 2017-02 Impact factor: 10.995
Authors: David J Tunnicliffe; Suetonia C Palmer; Lorna Henderson; Philip Masson; Jonathan C Craig; Allison Tong; Davinder Singh-Grewal; Robert S Flanc; Matthew A Roberts; Angela C Webster; Giovanni Fm Strippoli Journal: Cochrane Database Syst Rev Date: 2018-06-29
Authors: Farah Tamirou; David D'Cruz; Shirish Sangle; Philippe Remy; Carlos Vasconcelos; Christoph Fiehn; Maria del Mar Ayala Guttierez; Inge-Magrethe Gilboe; Maria Tektonidou; Daniel Blockmans; Isabelle Ravelingien; Véronique le Guern; Geneviève Depresseux; Loïc Guillevin; Ricard Cervera; Frédéric A Houssiau Journal: Ann Rheum Dis Date: 2015-03-10 Impact factor: 19.103