Xiaoyan Zhang1, Ling Ji2, Lichuan Yang2, Xiaohong Tang2, Wei Qin3. 1. West China School of Medicine, Sichuan University, Chengdu, China. 2. Division of Nephrology, Department of Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China. 3. Division of Nephrology, Department of Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China. ddqstrike@163.com.
Abstract
PURPOSE: To evaluate the efficacy and safety of the calcineurin inhibitors (CNIs) cyclosporine (CyA) and tacrolimus (TAC) in the induction and maintenance treatment of lupus nephritis (LN). METHODS: The Cochrane library, PubMed, Embase, and CENTRAL databases were searched and reviewed up to February 2015. Randomized controlled trials were analyzed using RevMan 5.2 software. RESULTS: Ten randomized controlled trials were selected and included in this study according to our inclusion and exclusion criteria, and six were included in the meta-analysis. The analysis results indicated that, in induction treatment, no statistically significant difference was observed in the rates of complete remission (CR), partial remission (PR), or response between the CNIs and intravenous cyclophosphamide (ivCYC). However, the rates of adverse events such as infection (RR 0.65, P = 0.04), leukocytopenia (RR 0.32, P = 0.04), and menstruation disorder (RR 0.37, P = 0.01) following the use of the CNIs were remarkably lower than those after ivCYC. No differences in the CR, PR, infection, or leukocytopenia rates were observed between the CNIs and mycophenolate mofetil (MMF). In the maintenance treatment period, the relapse rate between the CNIs and azathioprine (AZA) was similar (RR 0.44, P = 0.27), while the leukocytopenia rate was lower with the CNIs (RR 0.26, P = 0.0005). CONCLUSION: The efficacy of the CNIs CyA and TAC in induction therapy for lupus nephritis is comparable to ivCYC and MMF, and they are much safer than ivCYC. CNI treatment during the maintenance period was also as effective as AZA treatment, with a much lower risk of adverse effects. The CNIs CyA and TAC should be recommended for both induction and maintenance therapy of LN.
PURPOSE: To evaluate the efficacy and safety of the calcineurin inhibitors (CNIs) cyclosporine (CyA) and tacrolimus (TAC) in the induction and maintenance treatment of lupus nephritis (LN). METHODS: The Cochrane library, PubMed, Embase, and CENTRAL databases were searched and reviewed up to February 2015. Randomized controlled trials were analyzed using RevMan 5.2 software. RESULTS: Ten randomized controlled trials were selected and included in this study according to our inclusion and exclusion criteria, and six were included in the meta-analysis. The analysis results indicated that, in induction treatment, no statistically significant difference was observed in the rates of complete remission (CR), partial remission (PR), or response between the CNIs and intravenous cyclophosphamide (ivCYC). However, the rates of adverse events such as infection (RR 0.65, P = 0.04), leukocytopenia (RR 0.32, P = 0.04), and menstruation disorder (RR 0.37, P = 0.01) following the use of the CNIs were remarkably lower than those after ivCYC. No differences in the CR, PR, infection, or leukocytopenia rates were observed between the CNIs and mycophenolate mofetil (MMF). In the maintenance treatment period, the relapse rate between the CNIs and azathioprine (AZA) was similar (RR 0.44, P = 0.27), while the leukocytopenia rate was lower with the CNIs (RR 0.26, P = 0.0005). CONCLUSION: The efficacy of the CNIs CyA and TAC in induction therapy for lupus nephritis is comparable to ivCYC and MMF, and they are much safer than ivCYC. CNI treatment during the maintenance period was also as effective as AZA treatment, with a much lower risk of adverse effects. The CNIs CyA and TAC should be recommended for both induction and maintenance therapy of LN.
Authors: S A Namendys-Silva; J A Baltazar-Torres; E Rivero-Sigarroa; J A Fonseca-Lazcano; L Montiel-López; G Domínguez-Cherit Journal: Lupus Date: 2009-10-22 Impact factor: 2.911
Authors: C-C Szeto; B C-H Kwan; F M-M Lai; L-S Tam; E K-M Li; K-M Chow; W Gang; P K-T Li Journal: Rheumatology (Oxford) Date: 2008-08-27 Impact factor: 7.580
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: Eleni Kapsia; Smaragdi Marinaki; Ioannis Michelakis; George Liapis; Petros P Sfikakis; Maria G Tektonidou; John Boletis Journal: Front Med (Lausanne) Date: 2022-04-14