Cochrane · systematic review · CD002922

Immunosuppressive treatment for proliferative lupus nephritis

Tunnicliffe, DJ, Palmer, SC, Henderson, L, et al. · Cochrane Database of Systematic Reviews · 2018 · Cochrane Library

Kidney and Transplant2 versionsAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
18
current version
GRADE rated
18
No studies
0
Included studies
NR
No studies 0 · 0%Ungraded 0 · 0%Very low 5 · 27.8%Low 10 · 55.6%Moderate 3 · 16.7%High 0 · 0%

Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.

Questions and results

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Mycophenolate mofetil (MMF) versus IV cyclophosphamide (CPA) for induction therapy

Population: patients with induction therapy in lupus nephritis
8 questions
OutcomeEffectEvidenceStatus / GRADE
Death
Mycophenolate mofetil (MMF) vs IV cyclophosphamide (CPA)
RR 1.12 [0.61, 2.06]8 studies · 826 participantsVery low
ESKD
Mycophenolate mofetil (MMF) vs IV cyclophosphamide (CPA)
RR 0.71 [0.27, 1.84]3 studies · 231 participantsVery low
Complete renal remission
Mycophenolate mofetil (MMF) vs IV cyclophosphamide (CPA)
RR 1.17 [0.97, 1.42]8 studies · 828 participantsLow
Partial renal remission
Mycophenolate mofetil (MMF) vs IV cyclophosphamide (CPA)
RR 1.02 [0.89, 1.18]9 studies · 868 participantsLow
Ovarian failure
Mycophenolate mofetil (MMF) vs IV cyclophosphamide (CPA)
RR 0.36 [0.06, 2.18]3 studies · 539 participantsVery low
Major infection
Mycophenolate mofetil (MMF) vs IV cyclophosphamide (CPA)
RR 1.02 [0.67, 1.54]6 studies · 699 participantsLow
Alopecia
Mycophenolate mofetil (MMF) vs IV cyclophosphamide (CPA)
RR 0.29 [0.19, 0.46]3 studies · 622 participantsModerate
Diarrhoea
Mycophenolate mofetil (MMF) vs IV cyclophosphamide (CPA)
RR 2.42 [1.64, 3.58]4 studies · 609 participantsModerate

Mycophenolate mofetil (MMF) + tacrolimus (TAC) versus IV cyclophosphamide (CPA) for induction therapy

Population: Patients with proliferative lupus nephritis
3 questions
OutcomeEffectEvidenceStatus / GRADE
Complete renal remission
Mycophenolate mofetil (MMF) + tacrolimus (TAC) vs IV cyclophosphamide (CPA)
RR 2.38 [1.07, 5.3]2 studies · 402 participantsLow
Partial renal remission
Mycophenolate mofetil (MMF) + tacrolimus (TAC) vs IV cyclophosphamide (CPA)
RR 1 [0.78, 1.28]2 studies · 402 participantsLow
Stable kidney function
Mycophenolate mofetil (MMF) + tacrolimus (TAC) vs IV cyclophosphamide (CPA)
RR 1.78 [1.4, 2.26]2 studies · 402 participantsLow

Azathioprine (AZA) versus mycophenolate mofetil (MMF) for maintenance therapy

Population: patients with maintenance treatment in lupus nephritis
7 questions
OutcomeEffectEvidenceStatus / GRADE
Death
Azathioprine (AZA) vs mycophenolate mofetil (MMF)
RR 1.15 [0.34, 3.87]4 studies · 451 participantsVery low
ESKD
Azathioprine (AZA) vs mycophenolate mofetil (MMF)
RR 1.7 [0.52, 5.54]4 studies · 452 participantsVery low
Renal relapse
Azathioprine (AZA) vs mycophenolate mofetil (MMF)
RR 1.75 [1.2, 2.55]4 studies · 452 participantsModerate
Doubling of serum creatinine
Azathioprine (AZA) vs mycophenolate mofetil (MMF)
RR 2.19 [1.03, 4.66]4 studies · 452 participantsLow
Major infection
Azathioprine (AZA) vs mycophenolate mofetil (MMF)
RR 1.08 [0.69, 1.96]3 studies · 412 participantsLow
Leucopenia
Azathioprine (AZA) vs mycophenolate mofetil (MMF)
RR 5.61 [1.68, 18.72]3 studies · 412 participantsLow
Alopecia
Azathioprine (AZA) vs mycophenolate mofetil (MMF)
RR 0.95 [0.46, 1.95]3 studies · 412 participantsLow