Induction and maintenance treatment of proliferative lupus nephritis: a meta-analysis of randomized controlled trials.
Am J Kidney Dis
; 61(1): 74-87, 2013 Jan.
Article
en En
| MEDLINE
| ID: mdl-23182601
ABSTRACT
BACKGROUND:
Lupus nephritis accounts for ~1% of patients starting dialysis therapy. Treatment regimens combining cyclophosphamide with steroids preserve kidney function but have significant side effects. Newer immunosuppressive agents may have improved toxicity profiles. STUDYDESIGN:
Systematic review and random-effects meta-analysis, searching MEDLINE (1966 to April 2012), EMBASE (1988-2011), and the Cochrane Renal Group Specialised Register. SETTING & POPULATION Patients with biopsy-proven proliferative lupus nephritis (classes III, IV, V+III, and V+IV). SELECTION CRITERIA Randomized controlled trials. INTERVENTION Immunosuppressive treatment regimens used for induction and maintenance therapy of lupus nephritis.OUTCOMES:
Mortality, renal remission and relapse, doubling of creatinine level, proteinuria, incidence of end-stage kidney disease, ovarian failure, alopecia, leukopenia, infections, diarrhea, vomiting, malignancy, and bladder toxicity.RESULTS:
45 trials (2,559 participants) of induction therapy and 6 (514 participants) of maintenance therapy were included. In induction regimens comparing mycophenolate mofetil (MMF) with intravenous cyclophosphamide, there was no significant difference in mortality (7 studies, 710 patients; risk ratio [RR], 1.02; 95% CI, 0.52-1.98), incidence of end-stage kidney disease (3 studies, 231 patients; RR, 0.71; 95% CI, 0.27-1.84), complete renal remission (6 studies, 686 patients; RR, 1.39; 95% CI, 0.99-1.95), and renal relapse (1 study, 140 patients; RR, 0.97; 95% CI, 0.39-2.44). MMF-treated patients had significantly lower risks of ovarian failure (2 studies, 498 patients; RR, 0.15; 95% CI, 0.03-0.80) and alopecia (2 studies, 522 patients; RR, 0.22; 95% CI, 0.06-0.86). In maintenance therapy comparing azathioprine with MMF, the risk of renal relapse was significantly higher (3 studies, 371 patients; RR, 1.83; 95% CI, 1.24-2.71).LIMITATIONS:
Heterogeneity in interventions and definitions of remission and lack of long-term outcome reporting.CONCLUSIONS:
MMF is as effective as cyclophosphamide in achieving remission in lupus nephritis, but is safer, with a lower risk of ovarian failure. MMF is more effective than azathioprine in maintenance therapy for preventing relapse, with no difference in clinically important side effects.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Contexto en salud:
1_ASSA2030
/
3_ND
/
4_TD
/
6_ODS3_enfermedades_notrasmisibles
Problema de salud:
1_doencas_nao_transmissiveis
/
3_diarrhea
/
4_diarrhoeal_infections
/
6_immune_disorders
Asunto principal:
Nefritis Lúpica
/
Ensayos Clínicos Controlados Aleatorios como Asunto
/
Inmunosupresores
Tipo de estudio:
Clinical_trials
/
Systematic_reviews
Límite:
Humans
Idioma:
En
Revista:
Am J Kidney Dis
Año:
2013
Tipo del documento:
Article
País de afiliación:
Australia