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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 Syst+Rev
2016 ; 5
(1
): 155
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Comparative effectiveness of immunosuppressive drugs and corticosteroids for
lupus nephritis: a systematic review and network meta-analysis
#MMPMID27619512
Singh JA
; Hossain A
; Kotb A
; Wells GA
Syst Rev
2016[Sep]; 5
(1
): 155
PMID27619512
show ga
BACKGROUND: There is a lack of high-quality meta-analyses and network
meta-analyses of immunosuppressive drugs for lupus nephritis. Our objective was
to assess the comparative benefits and harms of immunosuppressive drugs and
corticosteroids in lupus nephritis. METHODS: We conducted a systematic review and
network meta-analysis (NMA) of trials of immunosuppressive drugs and
corticosteroids in patients with lupus nephritis. We calculated odds ratios (OR)
and 95 % credible intervals (CrI). RESULTS: Sixty-five studies that met inclusion
and exclusion criteria; data were analyzed for renal remission/response (37
trials; 2697 patients), renal relapse/flare (13 studies; 1108 patients),
amenorrhea/ovarian failure (eight trials; 839 patients) and cytopenia (16 trials;
2257 patients). Cyclophosphamide [CYC] low dose (LD) and CYC high-dose (HD) were
less likely than mycophenolate mofetil [MMF] and azathioprine [AZA], CYC LD, CYC
HD and plasmapharesis less likely than cyclosporine [CSA] to achieve renal
remission/response. Tacrolimus [TAC] was more likely than CYC LD to achieve renal
remission/response. MMF and CYC were associated with a lower odds of renal
relapse/flare compared to PRED and MMF was associated with a lower rate of renal
relapse/flare than AZA. CYC was more likely than MMF and PRED to be associated
with amenorrhea/ovarian failure. Compared to MMF, CYC, AZA, CYC LD, and CYC HD
were associated with a higher risk of cytopenia. CONCLUSIONS: In this systematic
review and NMA, we found important differences between immunosuppressives used
for the treatment of lupus nephritis. Patients and physicians can use this
information for detailed informed consent in a patient-centered approach. Study
limitations of between-study clinical heterogeneity and small sample size with
type II error must be considered when interpreting these findings. PROSPERO:
CRD42016032965.