title: A meta-analysis of randomized controlled trials comparing tacrolimus with intravenous cyclophosphamide in the induction treatment for lupus nephritis.
abstract: Lupus nephritis (LN) is a major cause of morbidity and mortality in systemic lupus erythematosus (SLE).  As a standard treatment regimen for remission induction of proliferative LN, intravenous cyclophosphamide (IVCYC) and corticosteroids has been widely accepted.  However, cyclophosphamide (CYC) is associated with significant adverse effects.  Tacrolimus, a T-cell-specific calcineurin inhibitor, shares similar immunosuppressive actions with cyclosporine.  We performed a meta-analysis of randomized controlled trials (RCTs) to compare efficacy and safety between tacrolimus (oral administration and/or IV injection) and IVCYC in the induction treatment for LN.  We identified 5 trials, including 225 patients.  Meta-analysis showed that tacrolimus could significantly increase complete remission (RR 1.61, 95% CI, 1.17 to 2.23; P = 0.004), response rate (RR 1.25, 95% CI, 1.09 to 1.44; P = 0.001), serum albumin level (SMD 1.11, 95% CI, 0.17 to 2.06; P = 0.02) and anti-dsDNA negative conversion rate (RR 1.34, 95% CI, 1.01 to 1.78; P = 0.04), and decrease urine protein (SMD -0.52, 95% CI, -0.83 to -0.22; P = 0.0008), systemic lupus erythematosus disease activity index (SLE-DAI) (SMD -0.59, 95% CI, -1.00 to -0.19; P = 0.004) compared with that of IVCYC.  The rates of gastrointestinal symptoms and irregular menstruation (or amenorrhea) were significantly lower in tacrolimus group than IVCYC group (RR 0.46, 95% CI, 0.22 to 0.93; P = 0.03 and RR 0.14, 95% CI, 0.04 to 0.50; P = 0.003).  In conclusion, tacrolimus was found to be more effective and safer than IVCYC as an induction therapy for Chinese LN patients.
authors: Department of Nephrology, The First Affiliated Hospital of Nanhua University, Hengyang, PR China.
authors: Jin
authors: J
authors: Deng
authors: Dongmei
authors: D
authors: Huo
authors: Qiaoyuan
authors: Q
authors: Wu
authors: Zhenhua
authors: Z
authors: Yang
authors: Yunhua
authors: Y
authors: Liao
mesh_terms: D000328:Adult; D003176:Complement C3 / Q000378:metabolism; D003520:Cyclophosphamide / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008181:Lupus Nephritis / Q000150:complications / Q000188:drug therapy*; D008297:Male; D011507:Proteinuria / Q000150:complications; D017594:Publication Bias; D016032:Randomized Controlled Trials as Topic; D012074:Remission Induction; D012709:Serum Albumin / Q000378:metabolism; D016559:Tacrolimus / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D003176:Complement C3; D012709:Serum Albumin; D003520:Cyclophosphamide; D016559:Tacrolimus