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Article: Mycophenolate mofetil is as efficacious as, but safer than, cyclophosphamide in the treatment of proliferative lupus nephritis: A meta-analysis and meta-regression

TitleMycophenolate mofetil is as efficacious as, but safer than, cyclophosphamide in the treatment of proliferative lupus nephritis: A meta-analysis and meta-regression
Authors
Issue Date2009
PublisherOxford University Press. The Journal's web site is located at http://rheumatology.oxfordjournals.org/
Citation
Rheumatology, 2009, v. 48 n. 8, p. 944-952 How to Cite?
AbstractObjective. Since mycophenolate mofetil (MMF) has emerged as an immunosuppressant for treating proliferative lupus nephritis, the role of cyclophosphamide (CYC)-containing regimens is being challenged. Efficacy data from randomized controlled trials (RCTs) and previous meta-analyses comparing these two agents for treating lupus nephritis have been inconsistent as they were heterogeneous in design and of small sample size. An updated meta-analysis is therefore required. Methods. Publications in the English literature were searched with the keywords 'mycophenoate', 'mycophenolic', 'lupus nephritis', 'nephritis' and 'glomerulonephritis' for RCTs in electronic databases. Primary outcome was relative risk (RR) of renal remission at 6 months. Secondary outcome included RRs of mortality, development of end-stage renal failure (ESRF) and side effects. Meta-regression was performed to identify factors explaining the heterogeneity of the effect sizes. Results. Ten eligible RCTs involving 847 patients were included. MMF offers similar efficacy in inducing renal remission as CYC (RR 1.052; 95% CI 0.950, 1.166) and the risks of death (RR 0.709; 95% CI 0.373, 1.347) and ESRF (RR 0.453; 95% CI 0.183, 1.121) were comparable. Significantly fewer patients receiving MMF developed amenorrhoea (RR 0.212; 95% CI 0.094, 0.479) and leucopenia (RR 0.473; 95% CI 0.269, 0.832) while the risks of herpes infection and pneumonia tended to be lower and that of diarrhoea appeared higher in the MMF groups. Meta-regression revealed that the non-white and non-Asian ethnicities contributed significantly to the heterogeneity of the effect sizes of renal remission. Conclusion. MMF offers similar efficacy in renal remission and survival as CYC. MMF appears safer than CYC in the treatment of proliferative lupus nephritis. © The Author 2009. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved.
Persistent Identifierhttp://hdl.handle.net/10722/163272
ISSN
2015 Impact Factor: 4.524
2015 SCImago Journal Rankings: 1.449
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorMak, Aen_US
dc.contributor.authorCheak, AACen_US
dc.contributor.authorTan, JYSen_US
dc.contributor.authorSu, HCen_US
dc.contributor.authorHo, RCMen_US
dc.contributor.authorLau, CSen_US
dc.date.accessioned2012-09-05T05:29:25Z-
dc.date.available2012-09-05T05:29:25Z-
dc.date.issued2009en_US
dc.identifier.citationRheumatology, 2009, v. 48 n. 8, p. 944-952en_US
dc.identifier.issn1462-0324en_US
dc.identifier.urihttp://hdl.handle.net/10722/163272-
dc.description.abstractObjective. Since mycophenolate mofetil (MMF) has emerged as an immunosuppressant for treating proliferative lupus nephritis, the role of cyclophosphamide (CYC)-containing regimens is being challenged. Efficacy data from randomized controlled trials (RCTs) and previous meta-analyses comparing these two agents for treating lupus nephritis have been inconsistent as they were heterogeneous in design and of small sample size. An updated meta-analysis is therefore required. Methods. Publications in the English literature were searched with the keywords 'mycophenoate', 'mycophenolic', 'lupus nephritis', 'nephritis' and 'glomerulonephritis' for RCTs in electronic databases. Primary outcome was relative risk (RR) of renal remission at 6 months. Secondary outcome included RRs of mortality, development of end-stage renal failure (ESRF) and side effects. Meta-regression was performed to identify factors explaining the heterogeneity of the effect sizes. Results. Ten eligible RCTs involving 847 patients were included. MMF offers similar efficacy in inducing renal remission as CYC (RR 1.052; 95% CI 0.950, 1.166) and the risks of death (RR 0.709; 95% CI 0.373, 1.347) and ESRF (RR 0.453; 95% CI 0.183, 1.121) were comparable. Significantly fewer patients receiving MMF developed amenorrhoea (RR 0.212; 95% CI 0.094, 0.479) and leucopenia (RR 0.473; 95% CI 0.269, 0.832) while the risks of herpes infection and pneumonia tended to be lower and that of diarrhoea appeared higher in the MMF groups. Meta-regression revealed that the non-white and non-Asian ethnicities contributed significantly to the heterogeneity of the effect sizes of renal remission. Conclusion. MMF offers similar efficacy in renal remission and survival as CYC. MMF appears safer than CYC in the treatment of proliferative lupus nephritis. © The Author 2009. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved.en_US
dc.languageengen_US
dc.publisherOxford University Press. The Journal's web site is located at http://rheumatology.oxfordjournals.org/en_US
dc.relation.ispartofRheumatologyen_US
dc.subject.meshCyclophosphamide - Therapeutic Useen_US
dc.subject.meshHumansen_US
dc.subject.meshImmunosuppressive Agents - Therapeutic Useen_US
dc.subject.meshKidney Failure, Chronic - Drug Therapyen_US
dc.subject.meshLupus Nephritis - Drug Therapyen_US
dc.subject.meshMycophenolic Acid - Analogs & Derivatives - Therapeutic Useen_US
dc.subject.meshRandomized Controlled Trials As Topicen_US
dc.subject.meshRegression Analysisen_US
dc.subject.meshTreatment Outcomeen_US
dc.titleMycophenolate mofetil is as efficacious as, but safer than, cyclophosphamide in the treatment of proliferative lupus nephritis: A meta-analysis and meta-regressionen_US
dc.typeArticleen_US
dc.identifier.emailLau, CS:cslau@hku.hken_US
dc.identifier.authorityLau, CS=rp01348en_US
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.doi10.1093/rheumatology/kep120en_US
dc.identifier.pmid19494179-
dc.identifier.scopuseid_2-s2.0-70149115258en_US
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-70149115258&selection=ref&src=s&origin=recordpageen_US
dc.identifier.volume48en_US
dc.identifier.issue8en_US
dc.identifier.spage944en_US
dc.identifier.epage952en_US
dc.identifier.eissn1462-0332-
dc.identifier.isiWOS:000268109000017-
dc.publisher.placeUnited Kingdomen_US
dc.identifier.scopusauthoridMak, A=9248521200en_US
dc.identifier.scopusauthoridCheak, AAC=34871425800en_US
dc.identifier.scopusauthoridTan, JYS=26326620300en_US
dc.identifier.scopusauthoridSu, HC=34873710700en_US
dc.identifier.scopusauthoridHo, RCM=23004658600en_US
dc.identifier.scopusauthoridLau, CS=14035682100en_US
dc.identifier.citeulike5711237-

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