Systematic evaluation of different doses of cyclophosphamide induction therapy for lupus nephritis

OBJECTIVE: This study systemically evaluated the efficacy and safety of intermittent intravenous pulse therapy with different doses of cyclophosphamide (CTX) for the treatment of lupus nephritis (LN). METHODS: We screened the Chinese Journal Full-text Database (CNKI, 1994–present), China Biology Medicine (CBMdisc, 1978–present), VIP Database for Chinese Technical Periodicals (1989–present), PubMed (1948–present), MEDLINE (Ovid SP, 1946–present), Embase (1947–present), and the Cochrane controlled trials register (13, 2017). Literature reports were selected according to the inclusion and exclusion criteria, effective data were extracted, research quality was evaluated, and RevMan5.2 was used for meta-analysis. RESULTS: Seven randomized controlled studies were included, consisting of 655 patients. The meta-analysis results showed no significant differences between the low- and high-dose cyclophosphamide groups in partial, complete, and total remission rates as well Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). Furthermore, there were no significant differences between the 2 groups in hematologic toxicity and gastrointestinal reaction, but the risk of infection (risk ratio [RR] = 0.74, 95% confidence interval [CI], 0.56–0.98, total effect inspection Z = 2.12, P = .03), and menstrual disorder (RR = 0.46, 95% CI, 0.31–0.69, total effect inspection Z = 3.83, P = .0001) decreased in the low-dose cyclophosphamide group. CONCLUSIONS: There was no obvious difference between the low- and high-dose cyclophosphamide groups in efficacy in the treatment of lupus nephritis, but the risk of infection and menstrual disorder significantly decreased in the low-dose group.