Relative efficacy and safety of tacrolimus, mycophenolate mofetil, and cyclophosphamide as induction therapy for lupus nephritis: a Bayesian network meta-analysis of randomized controlled trials

Lee, Young Ho; Song, Gwan Gyu

doi:10.1177/0961203315595131

Cited by 30 publications

(19 citation statements)

References 38 publications

(62 reference statements)

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“…5 A network analysis involving 9 trials in 972 patients concluded that tacrolimus was superior to cyclophosphamide for inducing complete or partial disease remission, whereas MMF was comparable to cyclophosphamide treatment. 6 The different conclusions drawn by these meta-analyses and the present study are likely due to the larger amount of information available in the present review to permit more precise inferences about competing treatments for lupus nephritis.…”

Section: Although Itmentioning

confidence: 70%

“…In a complex condition with several options for treatment, of which some have not been directly compared in trials, a network meta-analysis offers the potential to compare all therapeutic strategies simultaneously within a single framework and rank treatments per efficacy and safety. Network analysis has been used to evaluate induction therapy in lupus nephritis, but results have been inconclusive due to relatively few included studies 5,6 or reporting of drug harms only. 7 METHODS…”

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confidence: 99%

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Induction and Maintenance Immunosuppression Treatment of Proliferative Lupus Nephritis: A Network Meta-analysis of Randomized Trials

Palmer

Tunnicliffe

Singh‐Grewal

et al. 2017

American Journal of Kidney Diseases

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Evidence for induction therapy for lupus nephritis is inconclusive based on treatment effects on all-cause mortality, doubling of serum creatinine level, and end-stage kidney disease. MMF, calcineurin inhibitors, or their combination were most effective for inducing remission compared to IV cyclophosphamide, while conferring similar or lower treatment toxicity. MMF was the most effective maintenance therapy.

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Section: Although Itmentioning

confidence: 70%

mentioning

confidence: 99%

Induction and Maintenance Immunosuppression Treatment of Proliferative Lupus Nephritis: A Network Meta-analysis of Randomized Trials

Palmer

Tunnicliffe

Singh‐Grewal

et al. 2017

American Journal of Kidney Diseases

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“…Based on our study and previous meta-analyses27 28 there is level 1A evidence29 to support the clinical efficacy of TAC in the subgroup of Asian patients with LN. However, our study illustrated that a ‘grade A’ recommendation for TAC is hampered by the heterogeneity of TAC-based regimens studied in this subgroup of patients with LN.…”

Section: Discussionmentioning

confidence: 52%

“…Our data at the least suggest that the use of TAC is not inferior to conventional treatment. Moreover, we and others27 28 32 showed that the safety profile of TAC is very good in LN. Therefore, we would recommend TAC to be considered as a treatment option in patients with refractory LN.…”

Section: Discussionmentioning

confidence: 64%

TAC-TIC use of tacrolimus-based regimens in lupus nephritis

et al. 2016

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Current guidelines do not mention tacrolimus (TAC) as a treatment option and no consensus has been reported on the role of TAC in lupus nephritis (LN). The present study aimed to guide clinical judgement on the use of TAC in patients with LN. A meta-analysis was performed for clinical studies investigating TAC regimens in LN on the basis of treatment target (induction or maintenance), concomitant immunosuppression and quality of the data. 23 clinical studies performed in patients with LN were identified: 6 case series, 9 cohort studies, 2 case-control studies and 6 randomised controlled trials (RCTs). Of the 6 RCTs, 5 RCTs investigated TAC regimens as induction treatment and 1 RCT as maintenance treatment. Five RCTs investigated TAC in combination with steroids and 2 TAC with mycophenolate plus steroids. All RCTs were performed in patients of Asian ethnicity. In a meta-analysis, TAC regimens achieved a significantly higher total response (relative risk (RR) 1.23, 95% CI 1.12 to 1.34, p<0.05) and significantly higher complete response (RR 1.48, 95% CI 1.23 to 1.77, p<0.05). The positive outcome was predominantly defined by the largest RCT investigating TAC with mycophenolate plus steroids. Regarding safety, the occurrence of leucopoenia was significantly lower, while the occurrence of increased creatine was higher. Clinical studies on TAC regimens for LN are limited to patients of Asian ethnicity and hampered by significant heterogeneity. The positive results on clinical efficacy of TAC as induction treatment in LN cannot be extrapolated beyond Asian patients with LN. Therefore, further confirmation in multiethnic, randomised trials is mandatory. Until then, TAC can be considered in selected patients with LN.

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“…Для индукционной терапии ВН (классы III и IV) применяют режим Euro-Lupus, включающий низкую дозу циклофосфамида (ЦФ; 6 пульсов в течение 2 нед в фиксированной дозе 500 мг) [58], который не уступает по эффективности режиму, предложенному NIH (The National Institutes of Health) -750 мг/м 2 ежемесячно каждые 3 мес. В настоящее время в лечении ВН все более важное место занимают МФМ и ингибиторы кальциневрина, не уступающие по эффективности ЦФ (или превосходящие его) и более безопасные в отношении НЛР [59][60][61]. Напомним, что МФМ -иммуносупрессивный препарат, механизм действия которого связан с обратимой ингибицией фермента инозин-5-монофосфат-дегидрогеназы, участвующего в синтезе (de novo) гуанин нуклеотидов и 2-дезоксирибонуклеотида.…”

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