Induction and Maintenance Treatment of Lupus Nephritis: A Comprehensive Review of Meta-Analyses

Shin, Jae Il, Li, Han, Park, Seoyeon, Yang, Jae Won, Lee, Keum Hwa, Jo, Yongsuk, Park, Seongeun, Oh, Jungmin, Kim, Hansol, An, Hyo Jin, Jeong, Gahee, Jung, Haerang, Lee, Hyun Jung, Kim, Jae Seok, Nam, Seoung Wan, Koyanagi, Ai, Jacob, Louis, Hwang, Jimin, Yon, Dong Keon, Lee, Seung Won, Tizaoui, Kalthoum, Kronbichler, Andreas, Kim, Ji Hong and Smith, Lee (2022) Induction and Maintenance Treatment of Lupus Nephritis: A Comprehensive Review of Meta-Analyses. Journal of Clinical Medicine, 11 (2). p. 343. ISSN 2077-0383

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Abstract

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.

Item Type:	Journal Article
Keywords:	systemic lupus erythematosus, lupus nephritis, end-stage kidney disease, calcineurin inhibitor, glucocorticoids
Faculty:	Faculty of Science & Engineering
SWORD Depositor:	Symplectic User
Depositing User:	Symplectic User
Date Deposited:	20 Dec 2021 10:47
Last Modified:	16 Mar 2022 16:21
URI:	https://arro.anglia.ac.uk/id/eprint/707193

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