title: Efficacy and adverse events of mycophenolate mofetil versus cyclophosphamide for induction therapy of lupus nephritis: systematic review and meta-analysis.
abstract: We performed a systematic review and meta-analysis of randomized controlled trials to compare complete remission and adverse events (that is, infection, leukopenia, and gastrointestinal [GI] symptoms) between mycophenolate mofetil (MMF) and cyclophosphamide (CYC) for the treatment of lupus nephritis (LN). We identified trials from MEDLINE using the PubMed and Ovid search engines, and from The Cochrane Central Register of Randomized Controlled Trials. Eligible studies were randomized controlled trials comparing MMF with CYC with 1 of following outcomes: complete remission, complete/partial remission, infection, leukopenia, GI symptoms, serum creatinine, 24-hour urine protein, and urine albumin. Data were independently extracted by 2 reviewers. Five trials with a total of 638 patients were eligible for review. While the MMF group tended to achieve complete remission more frequently than the CYC group, this was not significant (pooled risk ratio [RR], 1.60; 95% confidence interval [CI], 0.87-2.93). Pooling based on the 4 homogeneous trials yielded similar results-that is, no benefit of MMF compared with CYC groups (RR, 1.15; 95% CI, 0.74-1.77). The complete or partial remission rates were also not different (pooled RR, 1.21; 95% CI, 0.97-1.48) among the groups. The adverse events (infection, renal function, and GI symptoms) were not significantly different, except for leukopenia, which was lower in the MMF group. In summary, patients treated with MMF and CYC had similar remission rates, but the MMF group had less frequent leukopenia than the CYC group. Further large-scale trials are needed to confirm these results.
authors.affiliation: From Section for Clinical Epidemiology and Biostatistics (NK, AT, AI), Research Centre; and Division of Allergy Immunology and Rheumatology (PN), Department of Medicine; Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; and Centre for Clinical Epidemiology and Biostatistics (MM, JA), The University of Newcastle, Newcastle, NSW, Australia.
authors.forename: Nanticha
authors.initials: N
authors.lastname: Kamanamool
authors.forename: Mark
authors.initials: M
authors.lastname: McEvoy
authors.forename: John
authors.initials: J
authors.lastname: Attia
authors.forename: Atiporn
authors.initials: A
authors.lastname: Ingsathit
authors.forename: Pintip
authors.initials: P
authors.lastname: Ngamjanyaporn
authors.forename: Ammarin
authors.initials: A
authors.lastname: Thakkinstian
mesh_terms: D003520:Cyclophosphamide / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D008181:Lupus Nephritis / Q000150:complications / Q000188:drug therapy*; D009173:Mycophenolic Acid / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D009173:Mycophenolic Acid