Management Of Lupus Nephritis: A Meta-analysis

Objective: To assess the efficacy and safety of intravenous cyclophosphamide, leflunomide/cyclosporineA/ tacrolimus/ mycophenolate mofetil plus glucocorticoid for Lupus Nephritis (LN).Methods: Controlled trials investigating the effects of leflunomide /cyclosporineA / tacrolimus / mycophenolate mofetil plus glucocorticoid with intravenous cyclophosphamide for Lupus Nephritis were retrieved by systematically searching MEDLINE, EMBASE,ovid,the Cochrane Library,SD,Chinese Biomedical , Chinese Conference data, and bibliographies from studies from January 1994 to October 2008. Two researchers collected data independentely, the quality of the studies was evaluated from the intention to treat analysis and allocation concealment, as well as by the Jadad method. The data were quantified by Meta-analysis.Results: 39 randomized clinical trials(RCTs)met the predetermined inclusion criteria, a total of 1998 patients included ( in the treatment group and in the control group 952/1046). The methodological quality was generally low. When all trials were pooled, the comparison between intravenous cyclophosphamide and leflunomide / mycophenolate mofetil plus glucocorticoid didn't elevate effective rate except for tacrolimus.In the analysis ,tacrolimus plus glucocorticoid is more effective than intravenous cyclophosphamide ,and the relative risks (RR) and 95%confidence interval(95%CI) were 0.24 (0.09,0.66). The use of leflunomide and mycophenolate mofetil showed statistically significant effects on anti-disDNA, the relative risks (RR) and 95% confidence interval (95%CI) were 2.72 (1.28,5.80), 2.38(1.43,3.95).While the use of mycophenolate mofetil also has significant effects on ANA,and the relative risks (RR) and 95%confidence interval (95%CI) were 1.82(1.14,2.90).Conclusion: Leflunomide / cyclosporineA / tacrolimus / mycophenolate mofetil plus glucocorticoid and intravenous cyclophosphamide,could elevate effective rate and protect renal function. But the comparison between intravenous cyclophosphamide and leflunomide / mycophenolate mofetil plus glucocorticoid is not on effective rate except for tacrolimus. The use of leflunomide and mycophenolate mofetil showed statistically significant effects on anti-disDNA ,and mycophenolate mofetil is also effective on ANA.Further studies which are well designed are needed.