Systematic Review and Network Meta-Analysis of Initial Treatments for Lupus Nephritis

IF 5.7 2区医学 Q1 UROLOGY & NEPHROLOGY

Kidney International Reports Pub Date : 2025-09-01 DOI:10.1016/j.ekir.2025.06.047

Ariel Izcovich , Fernando Tortosa , Agustín Bengolea , Moira Magdalena Pissinis , Martín Ragusa , Mariano Fielli , Camila Agnoletti , Rosana Quintana , Ana Malvar , Marina Scolnik , Eloisa Bonfá , Eduardo F. Borba , Odirlei Andre Monticielo , Edgard Torres dos Reis-Neto , Loreto Massardo , José A. Gómez-Puerta , Carlos Enrique Toro-Gutiérrez , Jorge A. Esquivel-Valerio , Hilda Fragoso Loyo , Juan Manuel Mejia-Vilet , Guillermo Pons-Estel

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引用次数: 0

Abstract

Introduction

This study aimed to evaluate the comparative efficacy and safety of various initial treatments for active lupus nephritis (LN) through a systematic review and network meta-analysis (NMA).

Methods

We conducted a comprehensive literature search across multiple databases from inception to February 2025 to identify randomized controlled trials (RCTs) comparing initial treatments for LN. We performed a frequentist random-effects NMA using the restricted maximum likelihood method to estimate heterogeneity. We used the GRADE approach to assess the certainty of evidence.

Results

We included 40 RCTs encompassing 5450 patients and 16 interventions (12 drugs administered alone or in combination). Mycophenolic acid analogs (MPAAs) were selected as the common comparator. The network meta-analysis revealed that voclosporin (VCS) combined with MPAA (risk difference [RD]: 281.38 more/1000, 95% confidence interval [CI]: 146.26 more to 456.42 more; high certainty), belimumab (BEL) combined with MPAA (RD: 145.02 more/1000, 95% CI: 72.73 more to 230.92 more; high certainty), and obinutuzumab (OBI) combined with MPAA (RD: 134.23 more/1000, 95% CI: 30.37 more to 269.68 more; moderate certainty) increased complete renal response (CRR) compared with MPAA alone. Tacrolimus (TAC) combined with MPAA (RD: 113.69 more/1000, 95% CI: 25.23 more to 217.7 more; low certainty) also showed potential benefits but with low certainty evidence.

Conclusion

Combination therapies, particularly VCS, BEL, or OBI with MPAA, provide enhanced outcomes for LN initial treatment. Given the complexity of LN, clinicians should weigh these findings alongside considerations such as drug availability, cost, and individual patient preferences to guide treatment decisions.

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狼疮性肾炎初始治疗的系统评价和网络荟萃分析

本研究旨在通过系统综述和网络荟萃分析（NMA）来评估各种初始治疗对活动性狼疮性肾炎（LN）的比较疗效和安全性。方法：我们在多个数据库中进行了全面的文献检索，从建立到2025年2月，以确定比较LN初始治疗的随机对照试验（rct）。我们使用限制最大似然法进行了频率随机效应NMA来估计异质性。我们使用GRADE方法来评估证据的确定性。我们纳入了40项随机对照试验，包括5450名患者和16项干预措施（12种药物单独或联合使用）。选择霉酚酸类似物（MPAAs）作为常用比较剂。网络荟萃分析显示，与单独使用MPAA相比，voclosporin （VCS）联合MPAA（风险差[RD]: 281.38 more/1000, 95%可信区间[CI]: 146.26 more ~ 456.42 more，高确定性）、贝利单抗（BEL）联合MPAA （RD: 145.02 more/1000, 95% CI: 72.73 more ~ 230.92 more，高确定性）和obinutuzumab （OBI）联合MPAA （RD: 134.23 more/1000, 95% CI: 30.37 more ~ 269.68 more，中等确定性）可提高完全肾反应（CRR）。他克莫司（TAC）联合MPAA （RD: 113.69多/1000,95% CI: 25.23多至217.7多；低确定性）也显示出潜在的益处，但证据的确定性较低。结论联合治疗，特别是VCS、BEL或OBI与MPAA联合治疗，可以提高LN初始治疗的效果。考虑到LN的复杂性，临床医生应该权衡这些发现以及药物可用性、成本和患者个人偏好等因素，以指导治疗决策。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Kidney International Reports Medicine-Nephrology

CiteScore

7.70

自引率

3.30%

发文量

1578

审稿时长

8 weeks

期刊介绍： Kidney International Reports, an official journal of the International Society of Nephrology, is a peer-reviewed, open access journal devoted to the publication of leading research and developments related to kidney disease. With the primary aim of contributing to improved care of patients with kidney disease, the journal will publish original clinical and select translational articles and educational content related to the pathogenesis, evaluation and management of acute and chronic kidney disease, end stage renal disease (including transplantation), acid-base, fluid and electrolyte disturbances and hypertension. Of particular interest are submissions related to clinical trials, epidemiology, systematic reviews (including meta-analyses) and outcomes research. The journal will also provide a platform for wider dissemination of national and regional guidelines as well as consensus meeting reports.