Induction and Maintenance Treatment of Lupus Nephritis: A Comprehensive Review of Meta-Analyses
journal contributionposted on 2023-08-30, 19:24 authored by Jae Il Shin, Han Li, Seoyeon Park, Jae Won Yang, Keum Hwa Lee, Yongsuk Jo, Seongeun Park, Jungmin Oh, Hansol Kim, Hyo Jin An, Gahee Jeong, Haerang Jung, Hyun Jung Lee, Jae Seok Kim, Seoung Wan Nam, Ai Koyanagi, Louis Jacob, Jimin Hwang, Dong Keon Yon, Seung Won Lee, Kalthoum Tizaoui, Andreas Kronbichler, Ji Hong Kim, Lee Smith
Background: Lupus nephritis (LN) is present in over 50% of patients with systemic lupus erythematosus (SLE) which is managed with immunosuppressive and immunomodulatory therapies. However, several novel therapeutic approaches for LN are under investigation due to the adverse effects spectrum of conventional therapy; Methods: We performed a comprehensive review of meta-analyses aggregating the comparative efficacies of various pharmacotherapies for LN. We conducted a literature search and retrieved a total of 23 meta-analyses and network meta-analyses for summarization. Pharmacotherapies were evaluated across six major outcomes: remission, relapse, mortality, end stage kidney disease (ESKD) progression, infection, and malignancy. Result: Calcineurin inhibitors (CNI), particularly tacrolimus (TAC), in combination with glucocorticoids (GC) outperformed cyclophosphamide (CPA) with GC in the rate of remission, either complete or partial remission, and in terms of infectious complications. In maintenance therapy, MMF was superior to azathioprine (AZA) as the MMF-treated patients had lower relapse rate. Interpretation: This review aggregates evidence of therapy for clinicians and sheds light on comparative efficacies of alternative LN treatments. As more promising agents are entering the market, such as voclosporin, belimumab, and obinutuzumab, LN management might undergo significant changes during the next years.
Publication titleJournal of Clinical Medicine
- Accepted version