Mycophenolate mofetil in induction and maintenance therapy of severe lupus nephritis: a meta-analysis of randomized controlled trials.
BACKGROUND
The outcomes of previous trials of mycophenolate mofetil (MMF) in treating severe lupus nephritis (LN) are not in exact agreement. This meta-analysis of randomized controlled trials (RCTs) assesses the benefits and harms of MMF in the induction and maintenance therapy of severe LN.


METHODS
We searched Medline, EMBASE and the Cochrane Collaboration Database for RCTs that compared MMF with other immunorepressive regimens for treating lupus nephritis and extracted data for remissions, side effects and prognosis in induction therapy and prognosis and side effects in maintenance therapy, and we summarized the combined results of the data of the RCTs as relative risk (RR).


RESULTS
We analysed five RCTs with 307 patients-four RCTS providing the data for comparing MMF with cyclophosphamide (CYC) for induction therapy and two RCTs providing the data for comparing MMF with azathioprine (AZA) for maintenance therapy of severe LN. Overall, compared with CYC, induction therapy with MMF reduced the risk of infection significantly (RR 0.65, P<0.001). It also significantly increased the complete remission rate compared with intravenous CYC (RR 3.10, P=0.006). Compared with intravenous CYC, induction therapy with MMF reduced the incidence of leucopenia significantly (RR 0.66, P=0.04). The prognosis and other side effects were not significantly different between MMF and CYC induction therapies. There was no significant difference between the patients receiving MMF and those receiving AZA for maintenance therapy in prognosis or the risks of amenorrhoea and herpes zoster.


CONCLUSIONS
MMF has higher efficacy in inducing remission in severe LN than pulsed intravenous therapy with CYC. Induction therapy with MMF is also associated with fewer side effects than induction therapy with CYC. Compared with AZA, MMF also is an alternative for maintenance therapy of severe LN without significant difference in the prognosis or risks of amenorrhoea and herpes zoster.
Zhu
Bin
B
Department of Nephrology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200025, China.
Chen
Nan
N
Lin
Yi
Y
Ren
Hong
H
Zhang
Wen
W
Wang
Weiming
W
Pan
XiaoXia
X
Yu
HaiJin
H
D001379:Azathioprine / Q000009:adverse effects / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D017053:Infection Control; D007970:Leukopenia / Q000139:chemically induced / Q000517:prevention & control; D008181:Lupus Nephritis / Q000188:drug therapy* / Q000503:physiopathology*; D009173:Mycophenolic Acid / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D012074:Remission Induction; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D009173:Mycophenolic Acid; D001379:Azathioprine