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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...

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Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
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.
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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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