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- Publisher Website: 10.1177/0961203319829817
- Scopus: eid_2-s2.0-85061607002
- PMID: 30744523
- WOS: WOS:000461555900010
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Article: Infectious complications in lupus nephritis treatment: a systematic review and meta-analysis
Title | Infectious complications in lupus nephritis treatment: a systematic review and meta-analysis |
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Authors | |
Keywords | Lupus nephritis infections cyclophosphamide mycophenonate mofetil tacrolimus |
Issue Date | 2019 |
Publisher | Sage Publications Ltd. The Journal's web site is located at http://lup.sagepub.com |
Citation | Lupus, 2019, v. 28 n. 3, p. 334-346 How to Cite? |
Abstract | Objectives:
Infection is an important concern in lupus nephritis treatment, but few studies have focused on this complication. Available data suggest marked variation in occurrence and outcome. This meta-analysis and review aims to provide an overview of infective complications, focusing on the risk factors and outcomes.
Methods:
Original articles on lupus nephritis Class III/IV/V published in the period January 1980 to December 2016 were identified from the Pubmed/Medline electronic database. Meta-analysis of randomized controlled trials was performed to investigate total and serious infections at different phases of treatment and their associated factors. A descriptive review that included all studies was also performed, providing details on the types of infection, infection-related mortality, and potential impact of different eras on infection rates.
Results:
A total of 56 studies (32 randomized controlled trials) were included. The incidence rates of overall and serious infections were higher during the induction than maintenance phase of therapy, with serious infections occurring at 8.2–50 and 3.5 per 100 patient-years, respectively. Recent data, predominantly from Asia, suggested lower rates of overall infections with induction regimens that included tacrolimus compared with mycophenolate (risk ratio 0.50, 95% confidence interval 0.33–0.76, p = 0.001). Mycophenolate as induction treatment was associated with lower overall infection risks than cyclophosphamide in non-Asians (risk ratio 0.60, 95% confidence interval 0.48–0.75, p < 0.001). The rates of serious infections were 4.1–25% in Asian and 4.4–8.5% in non-Asian countries; with infection-related mortality rates of 0–6.7% in Asian, compared to 0–2.1% in non-Asian locations.
Conclusions:
Infection remains a serious complication during treatment of lupus nephritis, but the reported rates and outcomes varied markedly. Mycophenolate was associated with lower infection risk than cyclophosphamide in non-Asians. Infection-related deaths appeared more common in Asian patients. |
Persistent Identifier | http://hdl.handle.net/10722/272925 |
ISSN | 2023 Impact Factor: 1.9 2023 SCImago Journal Rankings: 0.812 |
ISI Accession Number ID |
DC Field | Value | Language |
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dc.contributor.author | Thong, KM | - |
dc.contributor.author | Chan, TM | - |
dc.date.accessioned | 2019-08-06T09:19:11Z | - |
dc.date.available | 2019-08-06T09:19:11Z | - |
dc.date.issued | 2019 | - |
dc.identifier.citation | Lupus, 2019, v. 28 n. 3, p. 334-346 | - |
dc.identifier.issn | 0961-2033 | - |
dc.identifier.uri | http://hdl.handle.net/10722/272925 | - |
dc.description.abstract | Objectives: Infection is an important concern in lupus nephritis treatment, but few studies have focused on this complication. Available data suggest marked variation in occurrence and outcome. This meta-analysis and review aims to provide an overview of infective complications, focusing on the risk factors and outcomes. Methods: Original articles on lupus nephritis Class III/IV/V published in the period January 1980 to December 2016 were identified from the Pubmed/Medline electronic database. Meta-analysis of randomized controlled trials was performed to investigate total and serious infections at different phases of treatment and their associated factors. A descriptive review that included all studies was also performed, providing details on the types of infection, infection-related mortality, and potential impact of different eras on infection rates. Results: A total of 56 studies (32 randomized controlled trials) were included. The incidence rates of overall and serious infections were higher during the induction than maintenance phase of therapy, with serious infections occurring at 8.2–50 and 3.5 per 100 patient-years, respectively. Recent data, predominantly from Asia, suggested lower rates of overall infections with induction regimens that included tacrolimus compared with mycophenolate (risk ratio 0.50, 95% confidence interval 0.33–0.76, p = 0.001). Mycophenolate as induction treatment was associated with lower overall infection risks than cyclophosphamide in non-Asians (risk ratio 0.60, 95% confidence interval 0.48–0.75, p < 0.001). The rates of serious infections were 4.1–25% in Asian and 4.4–8.5% in non-Asian countries; with infection-related mortality rates of 0–6.7% in Asian, compared to 0–2.1% in non-Asian locations. Conclusions: Infection remains a serious complication during treatment of lupus nephritis, but the reported rates and outcomes varied markedly. Mycophenolate was associated with lower infection risk than cyclophosphamide in non-Asians. Infection-related deaths appeared more common in Asian patients. | - |
dc.language | eng | - |
dc.publisher | Sage Publications Ltd. The Journal's web site is located at http://lup.sagepub.com | - |
dc.relation.ispartof | Lupus | - |
dc.rights | Lupus. Copyright © Sage Publications Ltd. | - |
dc.rights | Copyright © [2019] The Author(s). DOI: [10.1177/0961203319829817] | - |
dc.subject | Lupus nephritis | - |
dc.subject | infections | - |
dc.subject | cyclophosphamide | - |
dc.subject | mycophenonate mofetil | - |
dc.subject | tacrolimus | - |
dc.title | Infectious complications in lupus nephritis treatment: a systematic review and meta-analysis | - |
dc.type | Article | - |
dc.identifier.email | Chan, TM: dtmchan@hkucc.hku.hk | - |
dc.identifier.authority | Chan, TM=rp00394 | - |
dc.description.nature | link_to_subscribed_fulltext | - |
dc.identifier.doi | 10.1177/0961203319829817 | - |
dc.identifier.pmid | 30744523 | - |
dc.identifier.scopus | eid_2-s2.0-85061607002 | - |
dc.identifier.hkuros | 300447 | - |
dc.identifier.volume | 28 | - |
dc.identifier.issue | 3 | - |
dc.identifier.spage | 334 | - |
dc.identifier.epage | 346 | - |
dc.identifier.isi | WOS:000461555900010 | - |
dc.publisher.place | United Kingdom | - |
dc.identifier.issnl | 0961-2033 | - |