Y H Lee1, G G Song2. 1. Division of Rheumatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea lyhcgh@korea.ac.kr. 2. Division of Rheumatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
Abstract
AIMS: This study aimed to assess the relative efficacy and safety of tacrolimus, mycophenolate mofetil (MMF) and cyclophosphamide (CYC) as induction therapy for lupus nephritis. METHODS: Randomized controlled trials (RCTs) examining the efficacy and safety of tacrolimus, MMF and CYC for induction therapy in patients with lupus nephritis were included. We performed a Bayesian random-effects network meta-analysis to combine direct and indirect evidence from the RCTs. RESULTS: Nine RCTs including 972 patients met the inclusion criteria and pair-wise comparisons were performed, including 11 direct comparisons. Tacrolimus showed a significantly higher overall response rate (complete remission plus partial remission) than CYC (OR 2.35, 95% confidence interval (CI) 1.03-5.45), and was more efficacious than MMF (OR 1.60, 95% CI 0.70-3.57). MMF was superior to CYC in terms of overall response (OR 1.45, 95% CI 0.96-2.42). Ranking probability based on the surface under the cumulative ranking curve (SUCRA) indicated that tacrolimus had the highest probability of being the best treatment for achieving the overall response (SUCRA = 0.9321), followed by MMF (SUCRA = 0.5385) and CYC (SUCRA = 0.0294). In terms of safety, tacrolimus showed the highest probability of decreasing the risk of serious infections (SUCRA = 0.9253), followed by MMF (SUCRA = 0.4027) and CYC (SUCRA = 0.1720). CONCLUSIONS: Tacrolimus was the most efficacious induction treatment for patients with lupus nephritis, and had the highest probability of decreasing the risk of serious infections. Higher remission rates combined with a more favorable safety profile suggest that MMF is superior to CYC as induction treatment in these patients.
AIMS: This study aimed to assess the relative efficacy and safety of tacrolimus, mycophenolate mofetil (MMF) and cyclophosphamide (CYC) as induction therapy for lupus nephritis. METHODS: Randomized controlled trials (RCTs) examining the efficacy and safety of tacrolimus, MMF and CYC for induction therapy in patients with lupus nephritis were included. We performed a Bayesian random-effects network meta-analysis to combine direct and indirect evidence from the RCTs. RESULTS: Nine RCTs including 972 patients met the inclusion criteria and pair-wise comparisons were performed, including 11 direct comparisons. Tacrolimus showed a significantly higher overall response rate (complete remission plus partial remission) than CYC (OR 2.35, 95% confidence interval (CI) 1.03-5.45), and was more efficacious than MMF (OR 1.60, 95% CI 0.70-3.57). MMF was superior to CYC in terms of overall response (OR 1.45, 95% CI 0.96-2.42). Ranking probability based on the surface under the cumulative ranking curve (SUCRA) indicated that tacrolimus had the highest probability of being the best treatment for achieving the overall response (SUCRA = 0.9321), followed by MMF (SUCRA = 0.5385) and CYC (SUCRA = 0.0294). In terms of safety, tacrolimus showed the highest probability of decreasing the risk of serious infections (SUCRA = 0.9253), followed by MMF (SUCRA = 0.4027) and CYC (SUCRA = 0.1720). CONCLUSIONS:Tacrolimus was the most efficacious induction treatment for patients with lupus nephritis, and had the highest probability of decreasing the risk of serious infections. Higher remission rates combined with a more favorable safety profile suggest that MMF is superior to CYC as induction treatment in these patients.
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: Puja P Khanna; Dinesh Khanna; Gary Cutter; Jeff Foster; Joshua Melnick; Sara Jaafar; Stephanie Biggers; A K M Fazlur Rahman; Hui-Chien Kuo; Michelle Feese; Alan Kivitz; Charles King; William Shergy; Jeff Kent; Paul M Peloso; Maria I Danila; Kenneth G Saag Journal: Arthritis Rheumatol Date: 2021-05-19 Impact factor: 15.483
Authors: Tineke Kraaij; Obbo W Bredewold; Stella Trompet; Tom W J Huizinga; Ton J Rabelink; Anton J M de Craen; Y K Onno Teng Journal: Lupus Sci Med Date: 2016-12-29
Authors: Mario E Alamilla-Sanchez; Miguel A Alcala-Salgado; Cesar D Alonso-Bello; Gandhy T Fonseca-Gonzalez Journal: Int J Nephrol Renovasc Dis Date: 2021-12-11