Treatments for lupus nephritis: A systematic review and network metaanalysis

Jasvinder A. Singh, Alomgir Hossain, Ahmed Kotb, Ana Oliveira, Amy S. Mudano, Jennifer Grossman, Kevin Winthrop, George A. Wells

Research output: Contribution to journalReview article

10 Citations (Scopus)

Abstract

Objective. To compare benefits and harms of lupus nephritis (LN) induction and maintenance treatments. Methods. We performed a systematic review and Bayesian network metaanalyses of randomized controlled trials (RCT) of immunosuppressive drugs or corticosteroids (CS) in LN. OR and 95% credible intervals (CrI) were calculated. Results. There were 65 RCT that met inclusion and exclusion criteria. Significantly lower risk of endstage renal disease (ESRD; 17 studies) was seen with cyclophosphamide (CYC; OR 0.49, 95% CrI 0.25-0.92) or CYC + azathioprine (AZA; OR 0.18, 95% CrI 0.05-0.57) compared with standard-dose CS, and with high-dose (HD) CYC (OR 0.16, 95% CrI 0.03-0.61) or CYC + AZA (OR 0.10, 95% CrI 0.03-0.34) compared with HD CS. HD CS was associated with higher risk of ESRD compared with CYC (OR 3.59, 95% CrI 1.30-9.86), AZA (OR 2.93, 95% CrI 1.08-8.10), or mycophenolate mofetil (MMF; OR 7.05, 95% CrI 1.66-31.91). Compared with CS, a significantly higher proportion of patients had renal response (14 studies) when treated with CYC (OR 1.98, 95% CrI 1.13-3.52), MMF (OR 2.42, 95% CrI 1.27-4.74), or tacrolimus (TAC; OR 4.20, 95% CrI 1.29-13.68). No differences were noted for the risk of malignancy (15 studies). The risk of herpes zoster (17 studies) was as follows: OR (95% CrI) MMF versus CS 4.38 (1.02-23.87), CYC versus CS 6.64 (1.97-25.71), TAC versus CS 9.11 (1.13-70.99), and CYC + AZA versus CS 8.46 (1.99-43.61). Conclusion. Renal benefits and the risk of herpes zoster were higher for immunosuppressive drugs versus CS. Data on relative and absolute differences are now available, which can be incorporated into patient-physician discussions related to systemic lupus erythematosus medication use.

Original languageEnglish (US)
Pages (from-to)1801-1815
Number of pages15
JournalJournal of Rheumatology
Volume43
Issue number10
DOIs
StatePublished - Oct 1 2016
Externally publishedYes

Fingerprint

Lupus Nephritis
Adrenal Cortex Hormones
Therapeutics
Herpes Zoster
Immunosuppressive Agents
Kidney
Chronic Kidney Failure
Randomized Controlled Trials
Mycophenolic Acid
Azathioprine
Tacrolimus
Pharmaceutical Preparations
Systemic Lupus Erythematosus
Cyclophosphamide
Physicians

Keywords

  • Lupus Nephritis
  • Metaanalysis
  • Network Metaanalysis
  • Systematic Review
  • Treatments

ASJC Scopus subject areas

  • Immunology and Allergy
  • Rheumatology
  • Immunology

Cite this

Singh, J. A., Hossain, A., Kotb, A., Oliveira, A., Mudano, A. S., Grossman, J., ... Wells, G. A. (2016). Treatments for lupus nephritis: A systematic review and network metaanalysis. Journal of Rheumatology, 43(10), 1801-1815. https://doi.org/10.3899/jrheum.160041

Treatments for lupus nephritis : A systematic review and network metaanalysis. / Singh, Jasvinder A.; Hossain, Alomgir; Kotb, Ahmed; Oliveira, Ana; Mudano, Amy S.; Grossman, Jennifer; Winthrop, Kevin; Wells, George A.

In: Journal of Rheumatology, Vol. 43, No. 10, 01.10.2016, p. 1801-1815.

Research output: Contribution to journalReview article

Singh, JA, Hossain, A, Kotb, A, Oliveira, A, Mudano, AS, Grossman, J, Winthrop, K & Wells, GA 2016, 'Treatments for lupus nephritis: A systematic review and network metaanalysis', Journal of Rheumatology, vol. 43, no. 10, pp. 1801-1815. https://doi.org/10.3899/jrheum.160041
Singh JA, Hossain A, Kotb A, Oliveira A, Mudano AS, Grossman J et al. Treatments for lupus nephritis: A systematic review and network metaanalysis. Journal of Rheumatology. 2016 Oct 1;43(10):1801-1815. https://doi.org/10.3899/jrheum.160041
Singh, Jasvinder A. ; Hossain, Alomgir ; Kotb, Ahmed ; Oliveira, Ana ; Mudano, Amy S. ; Grossman, Jennifer ; Winthrop, Kevin ; Wells, George A. / Treatments for lupus nephritis : A systematic review and network metaanalysis. In: Journal of Rheumatology. 2016 ; Vol. 43, No. 10. pp. 1801-1815.
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abstract = "Objective. To compare benefits and harms of lupus nephritis (LN) induction and maintenance treatments. Methods. We performed a systematic review and Bayesian network metaanalyses of randomized controlled trials (RCT) of immunosuppressive drugs or corticosteroids (CS) in LN. OR and 95{\%} credible intervals (CrI) were calculated. Results. There were 65 RCT that met inclusion and exclusion criteria. Significantly lower risk of endstage renal disease (ESRD; 17 studies) was seen with cyclophosphamide (CYC; OR 0.49, 95{\%} CrI 0.25-0.92) or CYC + azathioprine (AZA; OR 0.18, 95{\%} CrI 0.05-0.57) compared with standard-dose CS, and with high-dose (HD) CYC (OR 0.16, 95{\%} CrI 0.03-0.61) or CYC + AZA (OR 0.10, 95{\%} CrI 0.03-0.34) compared with HD CS. HD CS was associated with higher risk of ESRD compared with CYC (OR 3.59, 95{\%} CrI 1.30-9.86), AZA (OR 2.93, 95{\%} CrI 1.08-8.10), or mycophenolate mofetil (MMF; OR 7.05, 95{\%} CrI 1.66-31.91). Compared with CS, a significantly higher proportion of patients had renal response (14 studies) when treated with CYC (OR 1.98, 95{\%} CrI 1.13-3.52), MMF (OR 2.42, 95{\%} CrI 1.27-4.74), or tacrolimus (TAC; OR 4.20, 95{\%} CrI 1.29-13.68). No differences were noted for the risk of malignancy (15 studies). The risk of herpes zoster (17 studies) was as follows: OR (95{\%} CrI) MMF versus CS 4.38 (1.02-23.87), CYC versus CS 6.64 (1.97-25.71), TAC versus CS 9.11 (1.13-70.99), and CYC + AZA versus CS 8.46 (1.99-43.61). Conclusion. Renal benefits and the risk of herpes zoster were higher for immunosuppressive drugs versus CS. Data on relative and absolute differences are now available, which can be incorporated into patient-physician discussions related to systemic lupus erythematosus medication use.",
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AU - Hossain, Alomgir

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AU - Winthrop, Kevin

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N2 - Objective. To compare benefits and harms of lupus nephritis (LN) induction and maintenance treatments. Methods. We performed a systematic review and Bayesian network metaanalyses of randomized controlled trials (RCT) of immunosuppressive drugs or corticosteroids (CS) in LN. OR and 95% credible intervals (CrI) were calculated. Results. There were 65 RCT that met inclusion and exclusion criteria. Significantly lower risk of endstage renal disease (ESRD; 17 studies) was seen with cyclophosphamide (CYC; OR 0.49, 95% CrI 0.25-0.92) or CYC + azathioprine (AZA; OR 0.18, 95% CrI 0.05-0.57) compared with standard-dose CS, and with high-dose (HD) CYC (OR 0.16, 95% CrI 0.03-0.61) or CYC + AZA (OR 0.10, 95% CrI 0.03-0.34) compared with HD CS. HD CS was associated with higher risk of ESRD compared with CYC (OR 3.59, 95% CrI 1.30-9.86), AZA (OR 2.93, 95% CrI 1.08-8.10), or mycophenolate mofetil (MMF; OR 7.05, 95% CrI 1.66-31.91). Compared with CS, a significantly higher proportion of patients had renal response (14 studies) when treated with CYC (OR 1.98, 95% CrI 1.13-3.52), MMF (OR 2.42, 95% CrI 1.27-4.74), or tacrolimus (TAC; OR 4.20, 95% CrI 1.29-13.68). No differences were noted for the risk of malignancy (15 studies). The risk of herpes zoster (17 studies) was as follows: OR (95% CrI) MMF versus CS 4.38 (1.02-23.87), CYC versus CS 6.64 (1.97-25.71), TAC versus CS 9.11 (1.13-70.99), and CYC + AZA versus CS 8.46 (1.99-43.61). Conclusion. Renal benefits and the risk of herpes zoster were higher for immunosuppressive drugs versus CS. Data on relative and absolute differences are now available, which can be incorporated into patient-physician discussions related to systemic lupus erythematosus medication use.

AB - Objective. To compare benefits and harms of lupus nephritis (LN) induction and maintenance treatments. Methods. We performed a systematic review and Bayesian network metaanalyses of randomized controlled trials (RCT) of immunosuppressive drugs or corticosteroids (CS) in LN. OR and 95% credible intervals (CrI) were calculated. Results. There were 65 RCT that met inclusion and exclusion criteria. Significantly lower risk of endstage renal disease (ESRD; 17 studies) was seen with cyclophosphamide (CYC; OR 0.49, 95% CrI 0.25-0.92) or CYC + azathioprine (AZA; OR 0.18, 95% CrI 0.05-0.57) compared with standard-dose CS, and with high-dose (HD) CYC (OR 0.16, 95% CrI 0.03-0.61) or CYC + AZA (OR 0.10, 95% CrI 0.03-0.34) compared with HD CS. HD CS was associated with higher risk of ESRD compared with CYC (OR 3.59, 95% CrI 1.30-9.86), AZA (OR 2.93, 95% CrI 1.08-8.10), or mycophenolate mofetil (MMF; OR 7.05, 95% CrI 1.66-31.91). Compared with CS, a significantly higher proportion of patients had renal response (14 studies) when treated with CYC (OR 1.98, 95% CrI 1.13-3.52), MMF (OR 2.42, 95% CrI 1.27-4.74), or tacrolimus (TAC; OR 4.20, 95% CrI 1.29-13.68). No differences were noted for the risk of malignancy (15 studies). The risk of herpes zoster (17 studies) was as follows: OR (95% CrI) MMF versus CS 4.38 (1.02-23.87), CYC versus CS 6.64 (1.97-25.71), TAC versus CS 9.11 (1.13-70.99), and CYC + AZA versus CS 8.46 (1.99-43.61). Conclusion. Renal benefits and the risk of herpes zoster were higher for immunosuppressive drugs versus CS. Data on relative and absolute differences are now available, which can be incorporated into patient-physician discussions related to systemic lupus erythematosus medication use.

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