Tacrolimus Versus Cyclophosphamide In The Induction Treatment For Lupus Nephritis: A Systematic Review

Objective: To evaluate the efficacy and safety of tacrolimus versuscyclophosphamide in the induction treatment for lupus nephritis.Methods: The randomized controlled trials of tacrolimus versuscyclophosphamide in the induction treatment for lupus nephritis were searchedfrom Cochrane Central Register of Controlled Trials, PubMed, EMbase, CBMand CNKI. And we screened relevant studies according to predefined inclusionand exclusion criteria, evaluated the quality of the included studies, andperformed meta-analyses by using RevMan5.1software.Result:5RCTs, including225Chinese patients, were enrolled in the review.The results of meta-analysis showed that tacrolimus can significantly increasecomplete remission rate (RR=1.61,95%CI (1.17,2.23); P=0.004), response rate(RR=1.25,95%CI (1.09,1.44); P=0.001), serum albumin level (SMD1.11,95%CI (0.17,2.06); P=0.02) and anti-dsDNA negative conversion rate (RR1.34,95%CI (1.01,1.78); P=0.04), and decrease urine protein (SMD-0.52,95%CI(-0.83,-0.22); P=0.0008), SLE-DAI (SMD-0.59,95%CI (-1.00,-0.19);P=0.004), gastrointestinal symptoms rate (RR=0.46,95%CI (0.22,0.93); P=0.03)and irregular menstruation (or amenorrhea) rate (RR=0.14,95%CI (0.04,0.50); P=0.003) compared with that of cyclophosphamide. There were no differencesin partial remission, serum C3level, leucopenia, infection, alopecia, abnormalliver function, serum creatinine elevated, hypertension and hyperglycemiabetween the two regimens.Conclusion: Tacrolimus was found to be more effective and safer thancyclophosphamide as an induction treatment for lupus nephritis in Chinesepatients.