Induction therapy for membranous lupus nephritis: a systematic review and network meta‐analysis

Tang, Kuo‐Tung; Tseng, Chien-Hua; Hsieh, Tsu‐Yi; Chen, Der Yuan

doi:10.1111/1756-185x.13321

Cited by 18 publications

(15 citation statements)

References 45 publications

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“…17 A network meta-analysis of 206 patients with class V did not find any difference in renal response or reduction of proteinuria between various treatments (including CNI and MMF). 72 Regarding multitarget treatment, a meta-analysis of 8 trials that compared TAC + MMF versus CY showed superior efficacy of the former in class V (response rate (RR): 4.24, p = 0.02). 73…”

Section: Resultsmentioning

confidence: 99%

Management of lupus nephritis: a systematic literature review informing the 2019 update of the joint EULAR and European Renal Association-European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations

et al. 2020

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ObjectivesTo analyse the current evidence for the management of lupus nephritis (LN) informing the 2019 update of the EULAR/European Renal Association-European Dialysis and Transplant Association recommendations.MethodsAccording to the EULAR standardised operating procedures, a PubMed systematic literature review was performed, from January 1, 2012 to December 31, 2018. Since this was an update of the 2012 recommendations, the final level of evidence (LoE) and grading of recommendations considered the total body of evidence, including literature prior to 2012.ResultsWe identified 387 relevant articles. High-quality randomised evidence supports the use of immunosuppressive treatment for class III and class IV LN (LoE 1a), and moderate-level evidence supports the use of immunosuppressive treatment for pure class V LN with nephrotic-range proteinuria (LoE 2b). Treatment should aim for at least 25% reduction in proteinuria at 3 months, 50% at 6 months and complete renal response (<500–700 mg/day) at 12 months (LoE 2a-2b). High-quality evidence supports the use of mycophenolate mofetil/mycophenolic acid (MMF/MPA) or low-dose intravenous cyclophosphamide (CY) as initial treatment of active class III/IV LN (LoE 1a). Combination of tacrolimus with MMF/MPA and high-dose CY are alternatives in specific circumstances (LoE 1a). There is low-quality level evidence to guide optimal duration of immunosuppression in LN (LoE 3). In end-stage kidney disease, all methods of kidney replacement treatment can be used, with transplantation having the most favourable outcomes (LoE 2b).ConclusionsThere is high-quality evidence to guide the initial and subsequent phases of class III/IV LN treatment, but low-to-moderate quality evidence to guide treatment of class V LN, monitoring and optimal duration of immunosuppression.

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Section: Resultsmentioning

confidence: 99%

Management of lupus nephritis: a systematic literature review informing the 2019 update of the joint EULAR and European Renal Association-European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations

et al. 2020

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“…A deterioration in renal function and the development of end-stage renal disease occur in ~40% of patients with primary MGN ( 5 ). Proteinuria ( 6 , 7 ), edema ( 8 , 9 ), hyperlipidemia ( 10 , 11 ) and hypoalbuminemia ( 12 , 13 ) are non-specific clinical symptoms of MGN. However, renal biopsy is the only definitive diagnostic approach, although it is an invasive procedure.…”

Section: Introductionmentioning

confidence: 99%

Network analysis of membranous glomerulonephritis based on metabolomics data

et al. 2018

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Membranous glomerulonephritis (MGN) is one of the most frequent causes of nephrotic syndrome in adults. It is characterized by the thickening of the glomerular basement membrane in the renal tissue. The current diagnosis of MGN is based on renal biopsy and the detection of antibodies to the few podocyte antigens. Due to the limitations of the current diagnostic methods, including invasiveness and the lack of sensitivity of the current biomarkers, there is a requirement to identify more applicable biomarkers. The present study aimed to identify diagnostic metabolites that are involved in the development of the disease using topological features in the component-reaction-enzyme-gene (CREG) network for MGN. Significant differential metabolites in MGN compared with healthy controls were identified using proton nuclear magnetic resonance and gas chromatography-mass spectrometry techniques, and multivariate analysis. The CREG network for MGN was constructed, and metabolites with a high centrality and a striking fold-change in patients, compared with healthy controls, were introduced as putative diagnostic biomarkers. In addition, a protein-protein interaction (PPI) network, which was based on proteins associated with MGN, was built and analyzed using PPI analysis methods, including molecular complex detection and ClueGene Ontology. A total of 26 metabolites were identified as hub nodes in the CREG network, 13 of which had salient centrality and fold-changes: Dopamine, carnosine, fumarate, nicotinamide D-ribonucleotide, adenosine monophosphate, pyridoxal, deoxyguanosine triphosphate, L-citrulline, nicotinamide, phenylalanine, deoxyuridine, tryptamine and succinate. A total of 13 subnetworks were identified using PPI analysis. In total, two of the clusters contained seed proteins (phenylalanine-4-hydroxlylase and cystathionine γ-lyase) that were associated with MGN based on the CREG network. The following biological processes associated with MGN were identified using gene ontology analysis: ‘Pyrimidine-containing compound biosynthetic process’, ‘purine ribonucleoside metabolic process’, ‘nucleoside catabolic process’, ‘ribonucleoside metabolic process’ and ‘aromatic amino acid family metabolic process’. The results of the present study may be helpful in the diagnostic and therapeutic procedures of MGN. However, validation is required in the future.

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“…Similarly, several studies have found MMF more likely than CYC to attain CR during induction treatment. [ 13 , 34 – 37 ] A previous meta-analysis in Asian and non-Asian LN patients reported that MMF was 3.1 times more likely to produce CR than CYC ( P = .006). [ 13 ] Another meta-analysis including 65 studies documented that renal remission was more likely to be attained with MMF than with low- or high-dose CYC.…”

Section: Discussionmentioning

confidence: 99%

Mycophenolate mofetil in the treatment of Chinese patients with lupus nephritis

et al. 2020

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Induction therapy for membranous lupus nephritis: a systematic review and network meta‐analysis

Abstract: Our NMA demonstrated that both MMF and CNI are more effective than CS for induction therapy in MLN patients. However, there are limitations due to intra- and inter-study variability.

Cited by 18 publications

References 45 publications

Management of lupus nephritis: a systematic literature review informing the 2019 update of the joint EULAR and European Renal Association-European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations

Management of lupus nephritis: a systematic literature review informing the 2019 update of the joint EULAR and European Renal Association-European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations

Network analysis of membranous glomerulonephritis based on metabolomics data

Mycophenolate mofetil in the treatment of Chinese patients with lupus nephritis

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