Comparative efficacy and safety of low-dose and high-dose cyclophosphamide as induction therapy for lupus nephritis: a network meta-analysis; [Vergleichende Studie zu Wirksamkeit und Sicherheit von niedrig und hoch dosiertem Cyclophosphamid als Induktionstherapie bei Lupusnephritis: eine Netzwerk-Metaanalyse]

被引：0

作者：

Bae S.-C. ^{[1
]}

Lee Y.H. ^{[2
]}

机构：

[1] Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul

[2] Division of Rheumatology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul

来源：

Zeitschrift für Rheumatologie | 2019年 / 78卷 / 5期

关键词：

Cyclophosphamide; Euroregimen; Lupus nephritis; Network meta-analysis; NIH regimen;

D O I：

10.1007/s00393-018-0512-8

中图分类号：

学科分类号：

摘要：

Aim: To assess the relative efficacy and safety of low-dose cyclophosphamide (LCYC) and high-dose CYC (HCYC) as induction therapy for lupus nephritis. Methods: Bayesian random-effects network meta-analysis was performed to combine direct and indirect evidence from randomized controlled trials (RCTs) examining the efficacy and safety of LCYC, HCYC, and mycophenolate mofetil (MMF) for induction therapy in patients with lupus nephritis. Results: Eleven RCTs (1212 patients) were included. MMF and LCYC showed similar overall response rates (OR 1.02, 95% credible interval [CrI] 0.51–2.02), and MMF showed a higher efficacy than HCYC (OR 1.48, 95% CrI 0.99–2.44). Similarly, LCYC showed a higher overall response than HCYC (OR 1.46, 95% CrI 0.83–2.86). Ranking probability based on SUCRA (surface under the cumulative ranking curve) indicated that MMF had the highest probability of being the best treatment for achieving an overall response (SUCRA = 0.7461), followed by LCYC (SUCRA = 0.6978) and HCYC (SUCRA = 0.0561). LCYC showed the highest probability of decreasing the risk of serious infections (SUCRA = 0.8513), followed by MMF (SUCRA = 0.49387) and HCYC (SUCRA = 0.1548). Conclusion: LCYC was an efficacious induction treatment for patients with lupus nephritis and had the highest probability of decreasing the risk of serious infections. Higher response rates and a more favorable safety profile suggest that LCYC is a good option for induction treatment in these patients. © 2018, Springer Medizin Verlag GmbH, ein Teil von Springer Nature.

引用

页码：467 / 473

页数：6

共 28 条

[1]

Waldman M., Appel G.B., Update on the treatment of lupus nephritis, Kidney Int, 70, pp. 1403-1412, (2006)

[2]

Ahn S.-H., Jung J.H., Renal involvement in rheumatic diseases, J. Rheum. Dis., 24, pp. 174-184, (2017)

[3]

Neumann K., Wallace D.J., Azen C., Nessim S., Fichman M., Metzger A.L., Klinenberg J.R., Lupus in the 1980s: III. Influence of clinical variables, biopsy, and treatment on the outcome in 150 patients with lupus nephritis seen at a single center, Semin Arthritis Rheum, 25, pp. 47-55, (1995)

[4]

Austin H.A., Klippel J.H., Balow J.E., Le Riche N.G., Steinberg A.D., Plotz P.H., Decker J.L., Therapy of lupus nephritis, N. Engl. J. Med., 314, pp. 614-619, (1986)

[5]

Petri M., Cyclophosphamide: new approaches for systemic lupus erythematosus, Lupus, 13, pp. 366-371, (2004)

[6]

Houssiau F.A., Vasconcelos C., D'Cruz D., Et al., Immunosuppressive therapy in lupus nephritis: the Euro-Lupus Nephritis Trial, a randomized trial of low-dose versus high-dose intravenous cyclophosphamide, Arthritis Rheum, 46, pp. 2121-2131, (2002)

[7]

Sabry A., Abo-Zenah H., Medhat T., Sheashaa H., Mahmoud K., El-Huseini A., A comparative study of two intensified pulse cyclophosphamide remission-inducing regimens for diffuse proliferative lupus nephritis: an Egyptian experience, Int Urol Nephrol, 41, pp. 153-161, (2009)

[8]

Rathi M., Goyal A., Jaryal A., Et al., Comparison of low-dose intravenous cyclophosphamide with oral mycophenolate mofetil in the treatment of lupus nephritis, Kidney Int, 89, pp. 235-242, (2016)

[9]

Zhang X.W., Li C., Ma X.X., Zhao J.X., An Y., Liu S., Li Y., Li Z.G., Short-interval lower-dose intravenous cyclophosphamide as induction and maintenance therapy for lupus nephritis: a prospective observational study, Clin Rheumatol, 33, pp. 939-945, (2014)

[10]

Catala-Lopez F., Tobias A., Cameron C., Moher D., Hutton B., Network meta-analysis for comparing treatment effects of multiple interventions: an introduction, Rheumatol Int, 34, pp. 1489-1496, (2014)

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