Please use this identifier to cite or link to this item:
https://repository.monashhealth.org/monashhealthjspui/handle/1/42603
Title: | Induction and maintenance treatment of proliferative lupus nephritis: A meta-analysis of randomized controlled trials. | Authors: | Strippoli G.F.M.;Webster A.C.;Henderson L.K.;Masson P.;Craig J.C.;Roberts M.A.;Flanc R.S. | Institution: | (Henderson, Masson, Craig, Strippoli, Webster) Cochrane Renal Group, Centre for Kidney Research, Children's Hospital at Westmead, Sydney, Australia (Henderson, Webster) Centre for Transplant and Renal Research, Westmead Hospital, Department of Renal Medicine, Sydney, NSW 2145, Australia (Masson, Craig, Strippoli, Webster) Sydney School of Public Health, University of Sydney, Sydney, Australia (Roberts) Department of Nephrology, Austin Health, Heidelberg, Australia (Flanc) Department of Nephrology, Monash Medical Centre, Clayton, Australia (Strippoli) Department of Clinical Pharmacology and Epidemiology, Mario Negri Sud Consortium, Santa-Maria-Imbaro, Italy (Strippoli) Diaverum Medical Scientific Office, Lund, Sweden (Strippoli) Department of Emergency and Organ Transplantation, Section of Nephrology, University of Bari, Bari, Italy | Issue Date: | 31-Dec-2012 | Copyright year: | 2013 | Publisher: | W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399, United States) | Place of publication: | United States | Publication information: | American Journal of Kidney Diseases. 61 (1) (pp 74-87), 2013. Date of Publication: January 2013. | 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. Study Design: 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(s): Immunosuppressive treatment regimens used for induction and maintenance therapy of lupus nephritis. Outcome(s): 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. Result(s): 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). Limitation(s): Heterogeneity in interventions and definitions of remission and lack of long-term outcome reporting. Conclusion(s): 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. © 2012 National Kidney Foundation, Inc. | DOI: | http://monash.idm.oclc.org/login?url=http://dx.doi.org/10.1053/j.ajkd.2012.08.041 | PubMed URL: | 23182601 [http://www.ncbi.nlm.nih.gov/pubmed/?term=23182601] | ISSN: | 0272-6386 | URI: | https://repository.monashhealth.org/monashhealthjspui/handle/1/42603 | Type: | Review | Subjects: | enteric coated tablet fracture/si [Side Effect] gastrointestinal symptom/si [Side Effect] herpes zoster/si [Side Effect] human immunosuppressive treatment incidence kidney failure/si [Side Effect] leukopenia/si [Side Effect] *lupus erythematosus nephritis/dt [Drug Therapy] lupus erythematosus nephritis/dt [Drug Therapy] maintenance therapy Medline ovary insufficiency/si [Side Effect] phase 1 clinical trial (topic) plasmapheresis proliferative glomerulonephritis proteinuria/si [Side Effect] randomized controlled trial (topic) relapse/pc [Prevention] relapse/si [Side Effect] remission review risk side effect/si [Side Effect] single drug dose systematic review systemic lupus erythematosus urine sediment vomiting/si [Side Effect] azathioprine/ae [Adverse Drug Reaction] azathioprine/ct [Clinical Trial] azathioprine/cb [Drug Combination] azathioprine/cm [Drug Comparison] azathioprine/dt [Drug Therapy] corticosteroid/ct [Clinical Trial] corticosteroid/dt [Drug Therapy] creatinine/ec [Endogenous Compound] cyclophosphamide/ae [Adverse Drug Reaction] cyclophosphamide/ct [Clinical Trial] cyclophosphamide/ad [Drug Administration] cyclophosphamide/cb [Drug Combination] cyclophosphamide/cm [Drug Comparison] cyclophosphamide/dt [Drug Therapy] cyclophosphamide/iv [Intravenous Drug Administration] cyclophosphamide/po [Oral Drug Administration] cyclosporin/ae [Adverse Drug Reaction] cyclosporin/ct [Clinical Trial] cyclosporin/cm [Drug Comparison] cyclosporin/dt [Drug Therapy] cyclosporin A/ae [Adverse Drug Reaction] cyclosporin A/ct [Clinical Trial] cyclosporin A/cm [Drug Comparison] cyclosporin A/dt [Drug Therapy] heparin/cb [Drug Combination] heparin/dt [Drug Therapy] immunoglobulin/ct [Clinical Trial] immunoglobulin/cm [Drug Comparison] immunoglobulin/dt [Drug Therapy] immunoglobulin/iv [Intravenous Drug Administration] immunosuppressive agent/ct [Clinical Trial] immunosuppressive agent/dt [Drug Therapy] methylprednisolone/ct [Clinical Trial] methylprednisolone/cm [Drug Comparison] methylprednisolone/dt [Drug Therapy] methylprednisolone/iv [Intravenous Drug Administration] misoprostol/ct [Clinical Trial] misoprostol/cb [Drug Combination] misoprostol/cm [Drug Comparison] misoprostol/dt [Drug Therapy] mycophenolic acid/cb [Drug Combination] mycophenolic acid/dt [Drug Therapy] mycophenolic acid 2 morpholinoethyl ester/ae [Adverse Drug Reaction] mycophenolic acid 2 morpholinoethyl ester/ct [Clinical Trial] mycophenolic acid 2 morpholinoethyl ester/cm [Drug Comparison] mycophenolic acid 2 morpholinoethyl ester/dt [Drug Therapy] rituximab/ct [Clinical Trial] rituximab/cm [Drug Comparison] rituximab/dt [Drug Therapy] steroid/ct [Clinical Trial] steroid/ad [Drug Administration] steroid/cb [Drug Combination] steroid/cm [Drug Comparison] steroid/dt [Drug Therapy] steroid/iv [Intravenous Drug Administration] steroid/po [Oral Drug Administration] tacrolimus/ae [Adverse Drug Reaction] tacrolimus/ct [Clinical Trial] tacrolimus/cm [Drug Comparison] tacrolimus/dt [Drug Therapy] low drug dose membranous glomerulonephritis meta analysis mortality outcome assessment alopecia/si [Side Effect] avascular necrosis/si [Side Effect] Cochrane Library confidence interval creatinine blood level creatinine clearance data extraction diarrhea/si [Side Effect] disease classification dosage schedule comparison drug dose reduction drug fatality/si [Side Effect] drug megadose Embase dosage schedule comparison drug dose reduction drug fatality / side effect drug megadose Embase enteric coated tablet fracture / side effect gastrointestinal symptom / side effect herpes zoster / side effect human immunosuppressive treatment incidence kidney failure / side effect leukopenia / side effect low drug dose *lupus erythematosus nephritis / *drug therapy lupus erythematosus nephritis / drug therapy maintenance therapy Medline membranous glomerulonephritis meta analysis mortality outcome assessment ovary insufficiency / side effect phase 1 clinical trial (topic) plasmapheresis proliferative glomerulonephritis proteinuria / side effect randomized controlled trial (topic) relapse / prevention / side effect remission review risk side effect / side effect single drug dose systematic review systemic lupus erythematosus urine sediment alopecia / side effect vomiting / side effect avascular necrosis / side effect Cochrane Library confidence interval creatinine blood level creatinine clearance data extraction diarrhea / side effect disease classification |
Type of Clinical Study or Trial: | Systematic review and/or meta-analysis |
Appears in Collections: | Articles |
Show full item record
Items in Monash Health Research Repository are protected by copyright, with all rights reserved, unless otherwise indicated.