Effectiveness and safety of common therapeutic drugs for refractory lupus nephritis: A network meta‑analysis

Abstract

Previous studies have indicated that various drugs may be beneficial for the treatment of patients with refractory lupus nephritis (RLN). The present study aimed to evaluate the effectiveness and safety of common therapeutic drugs for the treatment of RLN using a network meta-analysis (NMA). NMA was performed using Stata 14.0 software. The odds ratio (OR) and 95% CI were calculated. A total of 19 studies comprising 1,127 patients were included. Common therapeutic drugs for RLN included glucocorticoids (GC), cyclophosphamide (CTX), mycophenolate mofetil (MMF), tacrolimus (TAC), leflunomide (LEF), cyclosporine A and rituximab (RTX). Evaluation of the effectiveness revealed that MMF + GC produced significantly higher overall responses (i.e. complete remission plus partial remission) and that MMF + GC (OR=2.58; 95% CI, 1.67–3.97), CTX + RTX + GC (OR=3.89; 95% CI, 1.60–9.45), CTX + LEF + GC (OR=3.05; 95% CI, 1.05–8.84) and CTX + TAC + GC (OR=6.22; 95% CI, 1.93–20.05) had significantly higher overall responses compared with those to the traditional treatment regimen (CTX + GC). Ranking probability based on the surface under the cumulative ranking curve indicated that CTX + TAC + GC had the highest probability (80.6%) of being the best treatment for achieving an overall response. In the safety evaluation, MMF + GC had a lower risk of infection than CTX + GC (OR=0.32; 95% CI, 0.11,0.88). There were no statistically significant differences in adverse reactions, including gastrointestinal reactions and leukopenia between any two treatment regimens. In conclusion, the regimen of CTX + TAC + GC exhibited a trend in superiority regarding clinical efficacy among common therapeutic drug treatments for RLN, while the regimen of CTX + GC had a higher probability to cause adverse effects among the nine interventions compared.

Biologische Therapie bei systemischem Lupus erythematodes, Antiphospholipid-Syndrom und Sjögren-Syndrom: evidenz- und praxisbasierte Leitlinien

“…Eine kürzlich durchgeführte Netzwerk-Metaanalyse verglich eine Zusatztherapie mit RTX mit einer Kombinationstherapie mit Leflunomid und Tacrolimus. Da die mit RTX behandelte Population jedoch augenscheinlich eine schwerere Erkrankung aufweist, waren die Schlussfolgerungen möglicherweise verzerrt [45].…”

Biological therapy in systemic lupus erythematosus, antiphospholipid syndrome, and Sjögren’s syndrome: evidence- and practice-based guidance

“…A pooled analysis of data from European cohorts showed that add-on treatment with RTX was successful in patients with type IV and type V LN – although less than in patients with type III ( 44 ). A recent network meta-analysis placed add-on therapy with RTX in line with combination treatment with leflunomide and tacrolimus but, since the population treated with RTX seems to have more severe disease, conclusions may have been biased ( 45 ).…”

The role of N6-methyladenosine (m6A) in kidney diseases

“…Among its various manifestations, LN is the most frequent and severe, occurring in up to 60% of patients with SLE. LN can lead to significant kidney damage, with hematuria and proteinuria being common clinical features ( 106 , 107 ).…”