title: The effect of calcineurin inhibitors in the induction and maintenance treatment of lupus nephritis: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To evaluate the efficacy and safety of the calcineurin inhibitors (CNIs) cyclosporine (CyA) and tacrolimus (TAC) in the induction and maintenance treatment of lupus nephritis (LN).
  
  
  METHODS
  The Cochrane library, PubMed, Embase, and CENTRAL databases were searched and reviewed up to February 2015. Randomized controlled trials were analyzed using RevMan 5.2 software.
  
  
  RESULTS
  Ten randomized controlled trials were selected and included in this study according to our inclusion and exclusion criteria, and six were included in the meta-analysis. The analysis results indicated that, in induction treatment, no statistically significant difference was observed in the rates of complete remission (CR), partial remission (PR), or response between the CNIs and intravenous cyclophosphamide (ivCYC). However, the rates of adverse events such as infection (RR 0.65, P = 0.04), leukocytopenia (RR 0.32, P = 0.04), and menstruation disorder (RR 0.37, P = 0.01) following the use of the CNIs were remarkably lower than those after ivCYC. No differences in the CR, PR, infection, or leukocytopenia rates were observed between the CNIs and mycophenolate mofetil (MMF). In the maintenance treatment period, the relapse rate between the CNIs and azathioprine (AZA) was similar (RR 0.44, P = 0.27), while the leukocytopenia rate was lower with the CNIs (RR 0.26, P = 0.0005).
  
  
  CONCLUSIONS
  The efficacy of the CNIs CyA and TAC in induction therapy for lupus nephritis is comparable to ivCYC and MMF, and they are much safer than ivCYC. CNI treatment during the maintenance period was also as effective as AZA treatment, with a much lower risk of adverse effects. The CNIs CyA and TAC should be recommended for both induction and maintenance therapy of LN.
authors.affiliation: West China School of Medicine, Sichuan University, Chengdu, China.
authors.forename: Xiaoyan
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Division of Nephrology, Department of Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
authors.forename: Ling
authors.initials: L
authors.lastname: Ji
authors.affiliation: Division of Nephrology, Department of Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
authors.forename: Lichuan
authors.initials: L
authors.lastname: Yang
authors.affiliation: Division of Nephrology, Department of Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
authors.forename: Xiaohong
authors.initials: X
authors.lastname: Tang
authors.affiliation: Division of Nephrology, Department of Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China. ddqstrike@163.com.
authors.forename: Wei
authors.initials: W
authors.lastname: Qin
mesh_terms: D001379:Azathioprine / Q000627:therapeutic use; D065095:Calcineurin Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D003520:Cyclophosphamide / Q000627:therapeutic use; D016572:Cyclosporine / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D060828:Induction Chemotherapy; D008181:Lupus Nephritis / Q000188:drug therapy*; D060046:Maintenance Chemotherapy; D009173:Mycophenolic Acid / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D016559:Tacrolimus / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D003520:Cyclophosphamide; D009173:Mycophenolic Acid; D001379:Azathioprine; D016559:Tacrolimus
keywords: CNIs; Cyclosporine (CyA); Lupus nephritis; Meta-analysis; Systematic review; Tacrolimus (TAC)