Analysis of the Clinical Effects of the Combination of Mycophenolate Mofetil with Either Tacrolimus or Cyclophosphamide

Zhang, Xuebing; Liu, Pei; Zhang, Zhen

doi:10.6061/clinics/2020/e1820

Cited by 5 publications

(1 citation statement)

References 23 publications

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“…8,9 Moreover, multitarget therapy has demonstrated signi cant e cacy in LN patients, and TAC is often used in combination with mycophenolate mofetil (MMF) and cyclophosphamide (CYC). [10][11][12] The combination therapy of TAC with other drugs can reduce dosages of TAC and other drugs, as well as drug-related organ damage and infections. [13][14][15] Multiple clinical studies have shown that the treatment regimen combining TAC with MMF or CYC has signi cant renal therapeutic effects for LN patients who have failed to respond to monotherapy.…”

Section: Introductionmentioning

confidence: 99%

The effect of tacrolimus combined with mycophenolate mofetil or cyclophosphamide on renal response in systemic lupus erythematosus patients

Sun,

Zhang,

Guo

et al. 2024

Preprint

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Objective This study aimed to determine the therapeutic effect of tacrolimus (TAC) and its combination with mycophenolate mofetil (MMF) or cyclophosphamide (CYC) on the complete response (CR) in patients with systemic lupus erythematosus (SLE). Methods A retrospective cohort study based on medical data was conducted among SLE patients taking at least one of TAC, MMF and CYC during 2010–2021. Odds ratio (OR) and 95% confidence interval (CI) were calculated and multiplicative interactions were estimated using logistic regression models. Results Among 793 SLE patients, 27.9% (221 cases) patients achieved CR after at least 3 months. TAC use was positively associated with CR with adjusted OR (95% CI) of 2.82(1.89, 4.22) in overall, as well as in subgroups of SLE patients with SLEDAI score > 12, moderate or severe urinary protein and comorbidities. The dose-response effect on CR was further observed at the dose of TAC more than 4 mg/d and more than 180 days, with adjusted OR (95% CI) of 5.65(2.35, 13.55), and 3.60(2.02, 6.41) respectively. Moreover, the combined effect of TAC with MMF or CYC was better than monotherapy with the significant multiplicative interaction, with adjusted OR (95% CI) of 2.43(1.20,4.92) and 3.14(1.49,6.64), respectively, and similar results were also observed for the combination of different doses of TAC with MMF or CYC. Conclusion TAC can effectively alleviate the condition of patients with SLE and may interact with MMF or CYC, suggesting that the combination therapy of TAC with MMF or CYC may produce greater benefits for patients with SLE. Trial registration: This is a purely observational study that does not require registration.

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Section: Introductionmentioning

confidence: 99%

The effect of tacrolimus combined with mycophenolate mofetil or cyclophosphamide on renal response in systemic lupus erythematosus patients

Sun,

Zhang,

Guo

et al. 2024

Preprint

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KDIGO 2024 Clinical Practice Guideline for the management of LUPUS NEPHRITIS

Rovin,

Ayoub,

Chan

et al. 2024

Kidney International

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Lupus nephritis randomised controlled trials: evidence gaps and under-represented groups

Nordmann-Gomes,

Cojuc-Konigsberg,

Hernández-Andrade

et al. 2024

Lupus Sci Med

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ObjectiveWe performed a scoping review of randomised clinical trials (RCTs) assessing pharmacological therapies for the initial management of lupus nephritis (LN), focusing on study design, included populations and outcome definitions, to assess the generalisability of their results and identify gaps in the evidence.MethodsRCTs evaluating pharmacological interventions for the initial therapy of LN published between 2000 and 2024 were evaluated. Extracted variables included study design, selection criteria, outcome definitions, populations recruited and clinical characteristics of participants. Each study arm was included as intervention and segregated into guideline-recommended regimens (cyclophosphamide (CYC), mycophenolic acid analogues (MPAAs), calcineurin inhibitors and belimumab) or other regimens. Data were analysed by descriptive statistics, and Fragility Index (FI) was estimated to assess robustness of studies.ResultsWe included 124 intervention arms within 61 RCT, involving 7058 participants. Seventy-nine arms (63.7%) corresponded to guideline-recommended therapies: 33 (26.6%) MPAA, 28 (22.6%) NIH-CYC and 7 (5.6%) triple-drug therapies. While 100% of triple-drug therapies RCT were multinational, only 7.1% of NIH-CYC and 0% of tacrolimus RCTs were conducted in more than one country. Only 9 (14.8%) had follow-up ≥24 months. Ten (16.4%) RCTs exclusively included participants with severe or refractory LN. Only 29 (47.5%) reported serious adverse events, and few described patient-reported outcomes. Black and other race participants were under-represented, as well as participants from Middle East, North Africa, and the sub-Saharan African region. Response was variably defined and assessed at different intervals. Robustness of RCTs evaluating double-drug guideline-recommended therapies were mostly low, with FI ranging from 1 to 3.ConclusionsConsidering new recommendations for the management of LN, we call for broader inclusion of under-represented populations and homogenisation of study design. This study provides the rationale for evaluating unexplored treatment comparisons and conducting research on newer interventions in clinical settings where evidence is currently lacking.

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Analysis of the Clinical Effects of the Combination of Mycophenolate Mofetil with Either Tacrolimus or Cyclophosphamide

Cited by 5 publications

References 23 publications

The effect of tacrolimus combined with mycophenolate mofetil or cyclophosphamide on renal response in systemic lupus erythematosus patients

The effect of tacrolimus combined with mycophenolate mofetil or cyclophosphamide on renal response in systemic lupus erythematosus patients

KDIGO 2024 Clinical Practice Guideline for the management of LUPUS NEPHRITIS

Lupus nephritis randomised controlled trials: evidence gaps and under-represented groups

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