Micofenolato o tacrolimus comparado conciclofosfamida en el tratamiento de nefritis lúpica: revisión sistemática y metaanálisis / Mycophenolate or tacrolimus compared with cyclophosphamide for the management of lupus nephritis: Systematic review and meta-analysis

RESUMEN

Objetivo: Realizar un metaanálisis de experimentos clínicos controlados comparando tasasde respuesta en remisión completa y parcial, además de efectos secundarios entre micofenolato(MF) y tacrolimus comparado con ciclofosfamida (CY), para el manejo de nefritislúpica.Materiales y métodos: Se identificaron experimentos clínicos a través de bases de datos deMEDLINE usando buscadores de PubMed, OVID y de Cochrane, LILACS, EMBASE, Academiade Medicina de Nueva York y resúmenes de congresos del ACR, EULAR, GLADEL. Los datosfueron extraídos independientemente por 2 revisores.Resultados: Para la comparación MF vs. CY se obtuvieron 9 experimentos clínicos, para untotal de 812 pacientes, evidenciando que MF tiene similar eficacia que CY en términos deremisión completa y parcial. No hubo diferencia en síntomas gastrointestinales, leucopeniani en muertes. Hay menor riesgo de irregularidades menstruales (RR 0,38; IC del 95% 0,20-0,73), infecciones (RR 0,64; IC del 95% 0,45-0,91) y menor riesgo de alopecia, (RR 0,25; ICdel 95% 0,16-0,38) en el grupo de MF. Para la comparación tacrolimus vs. CY, se obtuvieron3 experimentos clínicos, para un total de 146 pacientes, evidenciando que tacrolimus tienesimilar eficacia que CY en remisión completa y parcial; en el desenlace respuesta (remisióncompleta + parcial) se evidencia mayor beneficio de tacrolimus sobre CY (RR 1,21; IC del 95%1,02-1,45). No hubo diferencia en toxicidad entre tacrolimus y CY.Conclusiones: MF,tacrolimus y CY tienen similares tasas de remisión; sin embargo, hay mayorbeneficio en respuesta al comparar tacrolimus vs. CY. Comparando MF con CY hay menorriesgo de irregularidades menstruales, infecciones y alopecia...

ABSTRACT

ObjectiveTo perform a meta-analysis of controlled clinical trials to compare response rates of complete response and partial remission rates, as well as the adverse effects of immunosuppressive treatments, such as mycophenolate (MF) and tacrolimus, compared with cyclophosphamide (CY), for the management of lupus nephritis.Materials and methodsClinical trials were identified through MEDLINE database using PubMed, OVID and Cochrane search engines, LILACS, EMBASE, New York Academy of Medicine and conference proceedings from the ACR, EULAR, and GLADEL. Data were extracted independently by 2 reviewers.ResultsFor the comparison between MF and CY, 9 clinical trials were obtained, with a total of 812 patients, showing that MF has similar efficacy with CY in terms of complete and partial remission. There was no significant difference in gastrointestinal symptoms, leukopenia or deaths. There is less risk of menstrual abnormalities (RR 0.38, 95% CI 0.20-0.73), infections (RR 0.64; 95% CI 0.45-0.91) and less risk of hair loss (RR 0.25, 95% CI 0.16-0.38) in the MF group. For the comparison between tacrolimus and CY, 3 clinical trials were obtained, with a total 146 patients, showing that tacrolimus and CY have similar efficacy in complete and partial remission. In the outcome response (complete and partial remission), it was found that tacrolimus had a greater benefit than CY (RR 1.21, 95% CI 1.02-1.45). There was no significant difference in terms of toxicity between tacrolimus and CY.ConclusionsPatients treated with MF, tacrolimus and CY have similar rates of remission; however there is greater benefit in outcome response when comparing tacrolimus and CY. Comparing MF with CY showed a lower risk of menstrual abnormalities and reduced risk of alopecia...