Induction and Maintenance Treatment of Lupus Nephritis: A Comprehensive Review of Meta-Analyses.
Por:
Shin JI, Li H, Park S, Yang JW, Lee KH, Jo Y, Park S, Oh J, Kim H, An HJ, Jeong G, Jung H, Lee HJ, Kim JS, Nam SW, Koyanagi A, Jacob L., Hwang J, Yon DK, Lee SW, Tizaoui K, Kronbichler A, Kim JH and Smith L
Publicada:
11 ene 2022
Ahead of Print:
11 ene 2022
Categoría:
Medicine (miscellaneous)
Resumen:
BACKGROUND: Lupus nephritis (LN) is present in over 50% of patients with systemic lupus erythematosus (SLE) which is managed with immunosuppressive and immunomodulatory therapies. However, several novel therapeutic approaches for LN are under investigation due to the adverse effects spectrum of conventional therapy; Methods: We performed a comprehensive review of meta-analyses aggregating the comparative efficacies of various pharmacotherapies for LN. We conducted a literature search and retrieved a total of 23 meta-analyses and network meta-analyses for summarization. Pharmacotherapies were evaluated across six major outcomes: remission, relapse, mortality, end stage kidney disease (ESKD) progression, infection, and malignancy. RESULT: Calcineurin inhibitors (CNI), particularly tacrolimus (TAC), in combination with glucocorticoids (GC) outperformed cyclophosphamide (CPA) with GC in the rate of remission, either complete or partial remission, and in terms of infectious complications. In maintenance therapy, MMF was superior to azathioprine (AZA) as the MMF-treated patients had lower relapse rate. INTERPRETATION: This review aggregates evidence of therapy for clinicians and sheds light on comparative efficacies of alternative LN treatments. As more promising agents are entering the market, such as voclosporin, belimumab, and obinutuzumab, LN management might undergo significant changes during the next years.
Filiaciones:
Shin JI:
Department of Pediatrics, Yonsei University College of Medicine, Seoul 03722, Korea
Li H:
University of Florida College of Medicine, Gainesville, FL 32610, USA
Park S:
Yonsei University College of Medicine, Seoul 03722, Korea
Yang JW:
Department of Nephrology, Yonsei University Wonju College of Medicine, Wonju 26426, Korea
Lee KH:
Department of Pediatrics, Yonsei University College of Medicine, Seoul 03722, Korea
Jo Y:
Yonsei University College of Medicine, Seoul 03722, Korea
Park S:
Yonsei University College of Medicine, Seoul 03722, Korea
Oh J:
Yonsei University College of Medicine, Seoul 03722, Korea
Kim H:
Yonsei University College of Medicine, Seoul 03722, Korea
An HJ:
Yonsei University College of Medicine, Seoul 03722, Korea
Jeong G:
Ewha Womans University College of Medicine, Seoul 07804, Korea
Jung H:
Ewha Womans University College of Medicine, Seoul 07804, Korea
Lee HJ:
Ewha Womans University College of Medicine, Seoul 07804, Korea
Kim JS:
Department of Nephrology, Yonsei University Wonju College of Medicine, Wonju 26426, Korea
Nam SW:
Department of Rheumatology, Yonsei University Wonju College of Medicine, Wonju 26426, Korea
Koyanagi A:
Research and Development Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, 08830 Barcelona, Spain
Catalan Institution for Research and Advanced Studies, Pg. Lluis Companys 23, 08010 Barcelona, Spain
Centro de Investigación Biomédica en Red de Salud Mental, 78019 Madrid, Spain
Jacob L.:
Research and Development Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, 08830 Barcelona, Spain
Centro de Investigación Biomédica en Red de Salud Mental, 78019 Madrid, Spain
Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, 78000 Montigny-le-Bretonneux, France
Hwang J:
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
Yon DK:
Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul 02447, Korea
Lee SW:
Department of Data Science, Sejong University College of Software Convergence, Sungkyunkwan University School of Medicine, Seoul 05006, Korea
Tizaoui K:
Laboratory of Microorganisms and Active Biomolecules, Sciences Faculty of Tunis, University Tunis El Manar, Tunis 1068, Tunisia
Kronbichler A:
Department of Medicine, University of Cambridge, Cambridge CB2 0QQ, UK
Kim JH:
Department of Pediatrics, Yonsei University College of Medicine, Seoul 03722, Korea
Department of Pediatrics, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 26426, Korea
Smith L:
Centre for Health, Performance, and Wellbeing, Anglia Ruskin University, Cambridge CB1 1PT, UK
Green Published, Green Accepted, gold
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