Treatment for lupus nephritis: an overview of systematic reviews and meta-analyses

Chen, Yuehong; Sun, Jianhong; Zou, Kun; Yang, Yuan; Liu, Gang

doi:10.1007/s00296-017-3733-2

Cited by 38 publications

(26 citation statements)

References 38 publications

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“…Patients with LN undergoing treatment MMF for <24 months were more prone to renal recurrence compared with patients with LN who received MMF for induction therapy and continued to use MMF for a longer duration (31). However, a longer period of maintenance treatment may result in an increased risk of side effects caused by the accumulation of drugs (32). The present study demonstrated that among routine induction treatment schemes using glucocorticoids with various immunosuppressants, the difference in renal recurrence was not significant.…”

Section: Discussioncontrasting

confidence: 48%

Analysis of clinical risk factors in relapsed patients with class IV lupus nephritis

Wang

Chen

et al. 2018

Exp Ther Med

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The present study aimed to investigate risk factors for renal recurrence in patients with type IV lupus nephritis (LN). Univariate and multivariate analyses were conducted to using the Cox proportional hazard model and the Kaplan-Meier method. A total 244 patients were diagnosed with type IV LN; 100 (28.49%) relapsed and 144 (41.03%) recovered successfully. Kaplan-Meier method analysis indicated that patients with type IV LN affecting the digestive tract had high renal recurrence rates. Patients with hyperglobulinemia, positive anti-ribonucleoprotein and anti-Sjögren's syndrome type B (anti-SSB) antibodies, thrombus in the loop or non-inflammatory necrotizing vasculopathy also had a high recurrence rate. Furthermore, patients achieving partial remission had an increased recurrence rate compared with patients achieving complete remission. Patients undergoing maintenance treatment with glucocorticoids alone had a higher recurrence rate compared with patients who used alternative treatment schemes. Univariate and multivariate regression analyses by the Cox proportional hazard model determined that the effect of systemic lupus erythematosus in the gastrointestinal tract, increased serum globulin levels and positive anti-SSB antibody at onset were risk factors for the recurrence of LN type IV. The present study demonstrated that clinical risk factors of renal recurrence in patients with LN type IV include LN in the gastrointestinal tract, increased serum globulin levels, positive anti-SSB antibodies at onset and the use of glucocorticoid-only maintenance treatment.

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Section: Discussioncontrasting

confidence: 48%

Analysis of clinical risk factors in relapsed patients with class IV lupus nephritis

Wang

Chen

et al. 2018

Exp Ther Med

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“…6 Nonetheless, approximately 5%-20% of patients with LN will progress to endstage renal disease (ESRD) within 10 years after diagnosis despite receiving aggressive immunosuppressive therapy. [7][8][9] Although the causes and prognostic predictors of renal outcomes and mortality in LN have been studied, there is only limited data on LN in Japan. The recommendations for LN management published by the European League Against Rheumatism (EULAR)/European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) propose that a complete renal response (CR) or at least a partial renal response (PR) should be achieved preferably within 6 months and no later than 12 months after the initiation of treatment.…”

Section: Introductionmentioning

confidence: 99%

Factors predictive of long-term mortality in lupus nephritis: a multicenter retrospective study of a Japanese cohort

Ichinose

Kitamura

Sato

et al. 2019

Lupus

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Background: Lupus nephritis (LN) is a major determinant of mortality in systemic lupus erythematosus (SLE). Here we evaluated the association between complete renal response (CR) and mortality in LN. Methods: We retrospectively analyzed the cases of 172 of 201 patients with LN for whom data on the therapeutic response at 6 and 12 months after induction therapy were available. The patients underwent a renal biopsy at Nagasaki University Hospital and community hospitals in Nagasaki between the years 1990 and 2016. We determined the CR rates at 6 and 12 months after induction therapy induction and evaluated the predictive factors for CR and their relationship with mortality. We performed univariate and multivariable competing risks regression analyses to determine the factors predictive of CR. The patients' survival data were analyzed by the Kaplan-Meier method with a log-rank test. Results: The median follow-up duration after renal biopsy was 120 months (interquartile range: 60.3-191.8 months). The 5-, 10-, 15-and 20-year survival rates of our cohort were 99.3%, 94.6%, 92.0% and 85.4%, respectively. During follow-up, nine patients (5.2%) died from cardiovascular events, infection, malignancy and other causes. The multivariate analysis revealed that the following factors were predictive of CR. At 6 months: male gender (odds ratio [OR] 0.23, 95% confidence interval [CI] 0.08-0.65, p=0.0028), 4 proteinuria (g/gCr) (OR 0.83, 95%CI 0.71-0.97, p=0.0098) and index of activity (0-24) (OR 0.84, 95%CI 0.71-0.99, p=0.0382). At 12 months: male gender (OR 0.25, 95%CI 0.09-0.67, p=0.0043) and index of activity (0-24) (OR 0.82, 95%CI 0.69-0.98, p=0.0236). The Kaplan-Meier analysis showed that compared to not achieving CR at 12 months, achieving CR at 12 months was significantly correlated with the survival rate (OR 0.18, 95%CI 0.04-0.92, p=0.0339). Conclusions: Our results suggest that the survival rate of patients with LN is associated with the achievement of CR at 12 months after induction therapy, and that male gender and a higher index of activity (0-24) are the common predictive factors for failure to achieve CR at 6 and 12 months.

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“…However, the TAC + GC treatment showed higher incidence rates of hyperten-sion, hyperglycemia, herpes zoster or varicella, and blood creatinine level increase when compared with the CYC + GC treatment. In a previous study, Chen et al 28 included six studies into the meta-analysis and reported that TAC was superior to CYC in terms of CR rate, TR rate, and anti-dsDNA negative conversion rate. TAC was also associated with less adverse events of gastrointestinal syndrome and amenorrhea than CYC.…”

Section: Discussionmentioning

confidence: 99%

“…However, the incidence rate of blood creatinine increase in TAC + GC group was higher than that in MMF + GC group. In a previous study, Chen et al 28 included six studies into the meta-analysis and reported that, in the induction therapy of LN, TAC and MMF were more effective and safer when compared with CYC, but there were no differences of efficacy (CR, TR, proteinuria levels) or safety (major infection, serious infection) between the two treatments. Our meta-analysis included more studies and assessed more indicators than the previous meta-analyses.…”

Section: Discussionmentioning

confidence: 99%

<p>Efficacy and safety of tacrolimus in induction therapy of patients with lupus nephritis</p>

Zhou¹,

Lin

Shen³

et al. 2019

DDDT

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Background: The purpose of this study was to detect the efficacy and safety of tacrolimus (TAC) in induction therapy of patients with lupus nephritis. Methods: Associated studies were extracted from the PubMed and the Cochrane Library on July 10, 2018, and applicable investigations were pooled and analyzed by meta-analysis. Data on complete remission (CR), total remission (TR; complete plus partial remission), proteinuria levels, urine erythrocyte number, albumin, glomerular filtration rate, negative rate of ds-DNA, C 3 levels, C 4 levels, systemic lupus erythematosus disease activity index (SLE-DAI), etc, were extracted and pooled using RevMan 5.3. Results: In the therapeutic regimen of TAC + glucocorticoids (GC) vs cyclophosphamide (CYC) + GC, the results indicated that the TAC group had high values of CR, TR, albumin, and negative rate of ds-DNA, and low values of proteinuria levels and SLE-DAI when compared with those in CYC group (all P,0.05). In the therapeutic regimen comprising TAC + GC vs mycophenolate mofetil (MMF) + GC, the results indicated that the difference of CR, TR, proteinuria levels, and albumin between TAC group and MMF group were not significant (all P.0.05). In the therapeutic regimen comprising TAC + MMF + GC vs CYC + GC, multitarget therapy group showed higher values of CR, TR, urinary protein decline, and rise of serum albumin when compared with CYC group (all P,0.05). Conclusion: TAC is an effective and safe agent in induction therapy of patients with lupus nephritis.

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Treatment for lupus nephritis: an overview of systematic reviews and meta-analyses

Cited by 38 publications

References 38 publications

Analysis of clinical risk factors in relapsed patients with class IV lupus nephritis

Analysis of clinical risk factors in relapsed patients with class IV lupus nephritis

Factors predictive of long-term mortality in lupus nephritis: a multicenter retrospective study of a Japanese cohort

<p>Efficacy and safety of tacrolimus in induction therapy of patients with lupus nephritis</p>

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