Abstract
Although the accepted standard of care during the induction treatment of active lupus nephritis (LN) has been cyclophosphamide (CYC), recent trials suggest that calcineurin inhibitors (CNIs), which include cyclosporine A (CsA) and tacrolimus (TAC), may be just as, or even more, effective and less toxic than CYC. A systematic review and meta-analysis were performed to evaluate the clinical effects of CNIs on active LN compared with those of CYC. In the present study, clinical trials that compared CNIs with CYC in the induction therapy of active LN were searched in the Cochrane Library, Ovid and PubMed databases. The clinical data on renal remission and side-effects were collected and analyzed. The relative risk (RR) and 95% confidence intervals (CIs) were calculated. As a result, six controlled trials involving 265 patients were included in the meta-analysis, four of which compared TAC (treatment group) with CYC (control group), and the other two compared CsA (treatment group) with CYC (control group). CNIs were superior to CYC for higher complete remission (RR=1.56, 95% CI 1.14–2.15, Z=2.74, P=0.006) and better overall response/total remission (RR=1.23, 95% CI 1.07–1.42, Z=2.87, P=0.004) and had fewer side-effects. Among the CNIs, TAC demonstrated more favorable results than CsA. Therefore, it was concluded that CNIs may be a reasonable alternative to CYC in the induction treatment of active LN. However, large-scale, multicenter, well-designed clinical trials should be adopted to further confirm this conclusion.
Highlights
Lupus nephritis (LN) is a common and severe manifestation of systemic lupus erythematosus (SLE)
In the past 20 years, much evidence has supported that patients with active LN (International Society of Nephrology/Renal Pathology Society classes III, IV or V) may be effectively treated with corticosteroids combined with immunosuppressive drugs, for example, cyclophosphamide (CYC) or mycophenolate (MMF) [3,4,5]
Despite the relatively high renal remission rate following treatment with CYC, as many as 15% of patients with LN are refractory to treatment and up to 50% of patients develop end-stage renal disease (ESRD) during the treatment [23,24,25,26]
Summary
Lupus nephritis (LN) is a common and severe manifestation of systemic lupus erythematosus (SLE). A number of studies have demonstrated that TAC and CsA may provide equivalent potency and safety as an induction therapy in the treatment of active LN [9,10,11,12,13,14]. Given the increasing popularity of CNIs in the treatment of LN, a meta-analysis was performed in the current study to compare the efficacy and safety of CNIs with those of CYC in the treatment of active LN. This was carried out by analyzing the most recently published controlled trials, including large randomized controlled trials (RCTs), prospect cohort studies, and case‐control studies
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