Treatment Of Proliferative Lupus Nephritis: A Systematic Review

[Objective]To assess and compare the efficacy and safety of therapeutic agents applied in the treatment for proliferative lupus nephritis.[Methods]MEDLINE(1990 to August 2007),EMBASE(1990 to August 2007),PubMed(1990 to August 2007),CBM(1990 to August 2007)and some other databases have been searched for randomize controlled trials.Total clinical effective rate,complete remission rate,renal survival rate,patient survival rate and renal relapse rate have been used to compare the efficacy of therapeutic agents.When compare the safety of therapeutic agents,some side effects such as infection rate,amenorrhea rate,leukcopenia rate and diarrhoea have been used. Data were extracted and analyzed through using the software Stata 7.0.[Results]Fourteen randomize controlled trials involving 787 patients met the inclusion criteria.1.The Meta-analysis showed that the total clinical effective rate of MMF was significantly higher than that of intravenous cyclophosphamide,but there was no statistical meaning to compare the difference of treatment between MMF and cyclophosphamide + azathioprine. MMF was proved to be safer when compared with cyclophosphamide,or cyclophosphamide + azathioprine.2.When compared with methylprednisolone pulse alone,methylprednisolone used in conjunction with cyclophosphamide pulse therapy were found to be more statistically meaningful for the total clinical effective rate,but the conjoined pulse therapy showed more side effects than methylprednisolone or cyclophosphamide pulse alone.3.Methylprednisolone pulse in conjunction with azathioprine less effective than cyclophosphamide pulse in inducing therapy for renal relapse rate,and had higher infection rate.4. the renal survival rate,patient survival rate were not significantly difference from oral cyclophosphamide+azathioprine with intravenous methylprednisolone conjunction with cyclophosphamide pulse therapy,and the conjoined pulse therapy may had less side effect.5.Low-dose cyclophosphamide was not found statistically different efficacy from high-dose cyclophosphamide,but high-dose cyclophosphamide may have more side effect than the other.6.To compare MMF,cyclophosphamide and azathioprine used in maintenane therapy remissioned by inducing treatment used with cyclophosphamide,the patient survival rate of azathioprine were statistically improved with cyclophosphamide, but were not statistically different from those for MMF.And cyclophosphamide showed more side effect than MMF,azathioprin.7.Intravenous immunoglobulin was not found to be statistically more effective compared with cyclophosphamide for renal survivial and patient survival.8.Plasmapheresis used in conjuction with cyclophosphamide was not found to be statistically more effective compared with cyclophosphamide alone.9.The total clinical effective rate of FK506 were not statistically different from those for cyclophosphamide, as the inducing treatment in patients with classâ…£-G LN.However,it were statistically higher than those for cyclophosphamide,as the inducing treatment in patients with classâ…¤plusâ…£LN.But safety of FK506 was not statistically improved with cyclophosphamide.[Conclusion]Azathioprin used in maintenane therapy remissioned by inducing treatment used with cyclophosphamide is effective and safe.MMF is effective and safe in inducing treatment or in maintenane therapy,and is safer than cyclophosphamide.Intravenous immunoglobulin is safe and effective in in maintenane therapy.The addition of pulse/synchronization apheresis to cyclophosphamide therapy does not improve the course of patients with proliferative lupus nephritis.FK506 was an effective immunosuppressor,which had quick response,as the inducing treatment in patients with classâ…£LN and classâ…¤plusâ…£LN.But safety of FK506 was not improved with cyclophosphamide.More large-scale multi-center randomized trials are needed to investigate the therapeutic agents used in the treatment of proliferative lupus nephritis.