title: Maintenance therapy of lupus nephritis with mycophenolate or azathioprine: systematic review and meta-analysis.
abstract: OBJECTIVE
  The objective of this study was to summarize the comparative efficacy and safety of MMF and AZA as maintenance therapy for LN.
  
  
  METHODS
  Systematic review and meta-analysis of randomized clinical trials of MMF and AZA as maintenance therapy for LN were performed based on a sensitive search. Meta-regression was used to explore causes of heterogeneity. Safety was explored using crude and combined incidence rate ratios (IRRs) of the more frequent adverse events (AEs).
  
  
  RESULTS
  The search produced 7341 hits. Four randomized clinical trials and one long-term study were selected for detailed analysis. No significant differences between MMF and AZA were found in sustained remission, relapse, renal failure, creatinine increase or death. However, there was high heterogeneity in the design of studies, drug doses and treatment in the previous induction phase. Significant lower rates of discontinuation due to AEs occurred in the MMF group, with a relative risk (RR) of 0.60 (95% CI 0.41, 0.88) but significant risk of publication bias (Egger test, P = 0.012). Gastrointestinal manifestations were more common [combined IRR 1.68 (95% CI 1.06, 2.68)] and leucopoenia less frequent in the MMF group [combined IRR 0.14 (95% CI 0.05, 0.42)].
  
  
  CONCLUSIONS
  The available data does not support the superiority of MMF or AZA as maintenance therapy for LN. Nevertheless, the high heterogeneity of studies included in the analysis makes this contention questionable.
authors.affiliation: Rheumatology Department, Complejo Hospitalario Universitario de Santiago de Compostela, c/ Travesía da Choupana s/n, 15701 Santiago de Compostela, Spain. joseramon.maneiro.fernandez@sergas.es.
authors.forename: Jose R
authors.initials: JR
authors.lastname: Maneiro
authors.forename: Nicolas
authors.initials: N
authors.lastname: Lopez-Canoa
authors.forename: Eva
authors.initials: E
authors.lastname: Salgado
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Gomez-Reino
mesh_terms: D000328:Adult; D001379:Azathioprine / Q000009:adverse effects / Q000627:therapeutic use*; D019468:Disease Management; D006801:Humans; D008181:Lupus Nephritis / Q000188:drug therapy*; D009173:Mycophenolic Acid / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
chemical_list: D009173:Mycophenolic Acid; D001379:Azathioprine
keywords: azathioprine; lupus nephritis; mycophenolate mofetil