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Induction and Maintenance Treatment of Lupus Nephritis: A Comprehensive Review of Meta-Analyses
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 conv...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8780781/ https://www.ncbi.nlm.nih.gov/pubmed/35054037 http://dx.doi.org/10.3390/jcm11020343 |
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author | Shin, Jae Il Li, Han Park, Seoyeon Yang, Jae Won Lee, Keum Hwa Jo, Yongsuk Park, Seongeun Oh, Jungmin Kim, Hansol An, Hyo Jin Jeong, Gahee Jung, Haerang Lee, Hyun Jung Kim, Jae Seok Nam, Seoung Wan Koyanagi, Ai Jacob, Louis Hwang, Jimin Yon, Dong Keon Lee, Seung-Won Tizaoui, Kalthoum Kronbichler, Andreas Kim, Ji Hong Smith, Lee |
author_facet | Shin, Jae Il Li, Han Park, Seoyeon Yang, Jae Won Lee, Keum Hwa Jo, Yongsuk Park, Seongeun Oh, Jungmin Kim, Hansol An, Hyo Jin Jeong, Gahee Jung, Haerang Lee, Hyun Jung Kim, Jae Seok Nam, Seoung Wan Koyanagi, Ai Jacob, Louis Hwang, Jimin Yon, Dong Keon Lee, Seung-Won Tizaoui, Kalthoum Kronbichler, Andreas Kim, Ji Hong Smith, Lee |
author_sort | Shin, Jae Il |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-8780781 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-87807812022-01-22 Induction and Maintenance Treatment of Lupus Nephritis: A Comprehensive Review of Meta-Analyses Shin, Jae Il Li, Han Park, Seoyeon Yang, Jae Won Lee, Keum Hwa Jo, Yongsuk Park, Seongeun Oh, Jungmin Kim, Hansol An, Hyo Jin Jeong, Gahee Jung, Haerang Lee, Hyun Jung Kim, Jae Seok Nam, Seoung Wan Koyanagi, Ai Jacob, Louis Hwang, Jimin Yon, Dong Keon Lee, Seung-Won Tizaoui, Kalthoum Kronbichler, Andreas Kim, Ji Hong Smith, Lee J Clin Med Review 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. MDPI 2022-01-11 /pmc/articles/PMC8780781/ /pubmed/35054037 http://dx.doi.org/10.3390/jcm11020343 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Review Shin, Jae Il Li, Han Park, Seoyeon Yang, Jae Won Lee, Keum Hwa Jo, Yongsuk Park, Seongeun Oh, Jungmin Kim, Hansol An, Hyo Jin Jeong, Gahee Jung, Haerang Lee, Hyun Jung Kim, Jae Seok Nam, Seoung Wan Koyanagi, Ai Jacob, Louis Hwang, Jimin Yon, Dong Keon Lee, Seung-Won Tizaoui, Kalthoum Kronbichler, Andreas Kim, Ji Hong Smith, Lee Induction and Maintenance Treatment of Lupus Nephritis: A Comprehensive Review of Meta-Analyses |
title | Induction and Maintenance Treatment of Lupus Nephritis: A Comprehensive Review of Meta-Analyses |
title_full | Induction and Maintenance Treatment of Lupus Nephritis: A Comprehensive Review of Meta-Analyses |
title_fullStr | Induction and Maintenance Treatment of Lupus Nephritis: A Comprehensive Review of Meta-Analyses |
title_full_unstemmed | Induction and Maintenance Treatment of Lupus Nephritis: A Comprehensive Review of Meta-Analyses |
title_short | Induction and Maintenance Treatment of Lupus Nephritis: A Comprehensive Review of Meta-Analyses |
title_sort | induction and maintenance treatment of lupus nephritis: a comprehensive review of meta-analyses |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8780781/ https://www.ncbi.nlm.nih.gov/pubmed/35054037 http://dx.doi.org/10.3390/jcm11020343 |
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