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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| Format: | Article |
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MDPI AG
2022-01-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/11/2/343 |
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| author | Jae Il Shin Han Li Seoyeon Park Jae Won Yang Keum Hwa Lee Yongsuk Jo Seongeun Park Jungmin Oh Hansol Kim Hyo Jin An Gahee Jeong Haerang Jung Hyun Jung Lee Jae Seok Kim Seoung Wan Nam Ai Koyanagi Louis Jacob Jimin Hwang Dong Keon Yon Seung-Won Lee Kalthoum Tizaoui Andreas Kronbichler Ji Hong Kim Lee Smith |
| author_facet | Jae Il Shin Han Li Seoyeon Park Jae Won Yang Keum Hwa Lee Yongsuk Jo Seongeun Park Jungmin Oh Hansol Kim Hyo Jin An Gahee Jeong Haerang Jung Hyun Jung Lee Jae Seok Kim Seoung Wan Nam Ai Koyanagi Louis Jacob Jimin Hwang Dong Keon Yon Seung-Won Lee Kalthoum Tizaoui Andreas Kronbichler Ji Hong Kim Lee Smith |
| author_sort | Jae Il Shin |
| collection | DOAJ |
| 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. |
| first_indexed | 2024-03-10T01:13:57Z |
| format | Article |
| id | doaj.art-3410e714eb894759bbae4dd5c2d186c9 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T01:13:57Z |
| publishDate | 2022-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-3410e714eb894759bbae4dd5c2d186c92023-11-23T14:12:24ZengMDPI AGJournal of Clinical Medicine2077-03832022-01-0111234310.3390/jcm11020343Induction and Maintenance Treatment of Lupus Nephritis: A Comprehensive Review of Meta-AnalysesJae Il Shin0Han Li1Seoyeon Park2Jae Won Yang3Keum Hwa Lee4Yongsuk Jo5Seongeun Park6Jungmin Oh7Hansol Kim8Hyo Jin An9Gahee Jeong10Haerang Jung11Hyun Jung Lee12Jae Seok Kim13Seoung Wan Nam14Ai Koyanagi15Louis Jacob16Jimin Hwang17Dong Keon Yon18Seung-Won Lee19Kalthoum Tizaoui20Andreas Kronbichler21Ji Hong Kim22Lee Smith23Department of Pediatrics, Yonsei University College of Medicine, Seoul 03722, KoreaUniversity of Florida College of Medicine, Gainesville, FL 32610, USAYonsei University College of Medicine, Seoul 03722, KoreaDepartment of Nephrology, Yonsei University Wonju College of Medicine, Wonju 26426, KoreaDepartment of Pediatrics, Yonsei University College of Medicine, Seoul 03722, KoreaYonsei University College of Medicine, Seoul 03722, KoreaYonsei University College of Medicine, Seoul 03722, KoreaYonsei University College of Medicine, Seoul 03722, KoreaYonsei University College of Medicine, Seoul 03722, KoreaYonsei University College of Medicine, Seoul 03722, KoreaEwha Womans University College of Medicine, Seoul 07804, KoreaEwha Womans University College of Medicine, Seoul 07804, KoreaEwha Womans University College of Medicine, Seoul 07804, KoreaDepartment of Nephrology, Yonsei University Wonju College of Medicine, Wonju 26426, KoreaDepartment of Rheumatology, Yonsei University Wonju College of Medicine, Wonju 26426, KoreaResearch and Development Unit, Parc Sanitari Sant Joan de Deu, Sant Boi de Llobregat, 08830 Barcelona, SpainResearch and Development Unit, Parc Sanitari Sant Joan de Deu, Sant Boi de Llobregat, 08830 Barcelona, SpainDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USAMedical Science Research Institute, Kyung Hee University College of Medicine, Seoul 02447, KoreaDepartment of Data Science, Sejong University College of Software Convergence, Sungkyunkwan University School of Medicine, Seoul 05006, KoreaLaboratory of Microorganisms and Active Biomolecules, Sciences Faculty of Tunis, University Tunis El Manar, Tunis 1068, TunisiaDepartment of Medicine, University of Cambridge, Cambridge CB2 0QQ, UKDepartment of Pediatrics, Yonsei University College of Medicine, Seoul 03722, KoreaCentre for Health, Performance, and Wellbeing, Anglia Ruskin University, Cambridge CB1 1PT, UKBackground: 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.https://www.mdpi.com/2077-0383/11/2/343systemic lupus erythematosuslupus nephritisend-stage kidney diseasecalcineurin inhibitorglucocorticoids |
| spellingShingle | Jae Il Shin Han Li Seoyeon Park Jae Won Yang Keum Hwa Lee Yongsuk Jo Seongeun Park Jungmin Oh Hansol Kim Hyo Jin An Gahee Jeong Haerang Jung Hyun Jung Lee Jae Seok Kim Seoung Wan Nam Ai Koyanagi Louis Jacob Jimin Hwang Dong Keon Yon Seung-Won Lee Kalthoum Tizaoui Andreas Kronbichler Ji Hong Kim Lee Smith Induction and Maintenance Treatment of Lupus Nephritis: A Comprehensive Review of Meta-Analyses Journal of Clinical Medicine systemic lupus erythematosus lupus nephritis end-stage kidney disease calcineurin inhibitor glucocorticoids |
| 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 | systemic lupus erythematosus lupus nephritis end-stage kidney disease calcineurin inhibitor glucocorticoids |
| url | https://www.mdpi.com/2077-0383/11/2/343 |
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