Induction therapy for membranous lupus nephritis: a systematic review and network meta-analysis

Kuo Tung Tang, Chien Hua Tseng, Tsu Yi Hsieh, Der Yuan Chen

Research output: Contribution to journalReview article

6 Citations (Scopus)

Abstract

Aim: Membranous lupus glomerulonephritis (MLN) is associated with morbidities such as thromboembolism, peripheral edema and/or hyperlipidemia. However, treatment of MLN remains elusive. Methods: We performed systematic searches on MEDLINE, EMBASE and Cochrane Library database up to November, 2017. Eligible studies included randomized trials or cohort studies which evaluated different immunosuppressants in adult patients with pathologically proved MLN. No language restrictions were applied. Endpoints included complete remission (CR) as the primary outcome, and CR plus partial remission (PR) and proteinuria-reducing effect as secondary outcomes. Frequentist estimation of a network meta-analysis (NMA) random-effect model was performed. Results: Eight studies (206 patients) were included with a total of six immunosuppressants as an induction therapy for MLN. NMA results showed that both mycophenolate mofetil (MMF) and calcineurin inhibitors (CNI) are effective in the induction of CR and CR plus PR when compared with corticosteroids (CS) alone, but MMF and CNI are also associated with higher infection rates when compared with CS. Conclusion: Our NMA demonstrated that both MMF and CNI are more effective than CS for induction therapy in MLN patients. However, there are limitations due to intra- and inter-study variability.

Original languageEnglish
Pages (from-to)1163-1172
Number of pages10
JournalInternational Journal of Rheumatic Diseases
Volume21
Issue number6
DOIs
Publication statusPublished - Jun 1 2018

Fingerprint

Membranous Glomerulonephritis
Lupus Nephritis
Mycophenolic Acid
Adrenal Cortex Hormones
Immunosuppressive Agents
Therapeutics
Remission Induction
Thromboembolism
Hyperlipidemias
Proteinuria
MEDLINE
Libraries
Edema
Cohort Studies
Language
Network Meta-Analysis
Databases
Morbidity
Infection
Calcineurin Inhibitors

Keywords

  • lupus nephritis
  • mycophenolic acid
  • systemic lupus erythematosus
  • tacrolimus

ASJC Scopus subject areas

  • Rheumatology

Cite this

Induction therapy for membranous lupus nephritis : a systematic review and network meta-analysis. / Tang, Kuo Tung; Tseng, Chien Hua; Hsieh, Tsu Yi; Chen, Der Yuan.

In: International Journal of Rheumatic Diseases, Vol. 21, No. 6, 01.06.2018, p. 1163-1172.

Research output: Contribution to journalReview article

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abstract = "Aim: Membranous lupus glomerulonephritis (MLN) is associated with morbidities such as thromboembolism, peripheral edema and/or hyperlipidemia. However, treatment of MLN remains elusive. Methods: We performed systematic searches on MEDLINE, EMBASE and Cochrane Library database up to November, 2017. Eligible studies included randomized trials or cohort studies which evaluated different immunosuppressants in adult patients with pathologically proved MLN. No language restrictions were applied. Endpoints included complete remission (CR) as the primary outcome, and CR plus partial remission (PR) and proteinuria-reducing effect as secondary outcomes. Frequentist estimation of a network meta-analysis (NMA) random-effect model was performed. Results: Eight studies (206 patients) were included with a total of six immunosuppressants as an induction therapy for MLN. NMA results showed that both mycophenolate mofetil (MMF) and calcineurin inhibitors (CNI) are effective in the induction of CR and CR plus PR when compared with corticosteroids (CS) alone, but MMF and CNI are also associated with higher infection rates when compared with CS. Conclusion: Our NMA demonstrated that both MMF and CNI are more effective than CS for induction therapy in MLN patients. However, there are limitations due to intra- and inter-study variability.",
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N2 - Aim: Membranous lupus glomerulonephritis (MLN) is associated with morbidities such as thromboembolism, peripheral edema and/or hyperlipidemia. However, treatment of MLN remains elusive. Methods: We performed systematic searches on MEDLINE, EMBASE and Cochrane Library database up to November, 2017. Eligible studies included randomized trials or cohort studies which evaluated different immunosuppressants in adult patients with pathologically proved MLN. No language restrictions were applied. Endpoints included complete remission (CR) as the primary outcome, and CR plus partial remission (PR) and proteinuria-reducing effect as secondary outcomes. Frequentist estimation of a network meta-analysis (NMA) random-effect model was performed. Results: Eight studies (206 patients) were included with a total of six immunosuppressants as an induction therapy for MLN. NMA results showed that both mycophenolate mofetil (MMF) and calcineurin inhibitors (CNI) are effective in the induction of CR and CR plus PR when compared with corticosteroids (CS) alone, but MMF and CNI are also associated with higher infection rates when compared with CS. Conclusion: Our NMA demonstrated that both MMF and CNI are more effective than CS for induction therapy in MLN patients. However, there are limitations due to intra- and inter-study variability.

AB - Aim: Membranous lupus glomerulonephritis (MLN) is associated with morbidities such as thromboembolism, peripheral edema and/or hyperlipidemia. However, treatment of MLN remains elusive. Methods: We performed systematic searches on MEDLINE, EMBASE and Cochrane Library database up to November, 2017. Eligible studies included randomized trials or cohort studies which evaluated different immunosuppressants in adult patients with pathologically proved MLN. No language restrictions were applied. Endpoints included complete remission (CR) as the primary outcome, and CR plus partial remission (PR) and proteinuria-reducing effect as secondary outcomes. Frequentist estimation of a network meta-analysis (NMA) random-effect model was performed. Results: Eight studies (206 patients) were included with a total of six immunosuppressants as an induction therapy for MLN. NMA results showed that both mycophenolate mofetil (MMF) and calcineurin inhibitors (CNI) are effective in the induction of CR and CR plus PR when compared with corticosteroids (CS) alone, but MMF and CNI are also associated with higher infection rates when compared with CS. Conclusion: Our NMA demonstrated that both MMF and CNI are more effective than CS for induction therapy in MLN patients. However, there are limitations due to intra- and inter-study variability.

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