TY - JOUR
T1 - Induction therapy for membranous lupus nephritis
T2 - a systematic review and network meta-analysis
AU - Tang, Kuo Tung
AU - Tseng, Chien Hua
AU - Hsieh, Tsu Yi
AU - Chen, Der Yuan
PY - 2018/6/1
Y1 - 2018/6/1
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.
KW - lupus nephritis
KW - mycophenolic acid
KW - systemic lupus erythematosus
KW - tacrolimus
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U2 - 10.1111/1756-185X.13321
DO - 10.1111/1756-185X.13321
M3 - Review article
C2 - 29879319
AN - SCOPUS:85048266340
VL - 21
SP - 1163
EP - 1172
JO - APLAR Journal of Rheumatology
JF - APLAR Journal of Rheumatology
SN - 1756-1841
IS - 6
ER -