背景:关于评估他克莫司(TAC)的有效性和安全性的随机对照试验(RCT)的数据有限,环孢菌素A(CSA),霉酚酸酯(MMF),环磷酰胺(CYC),和皮质类固醇作为膜性狼疮性肾炎的诱导剂,他们没有定论。
目的:本研究旨在评估TAC的相对有效性和安全性,CSA,MMF,CYC,和皮质类固醇作为膜性狼疮性肾炎的诱导疗法。
方法:RCT检查TAC的疗效和安全性,CSA,MMF,CYC,和糖皮质激素作为膜性狼疮性肾炎患者的诱导治疗。我们进行了贝叶斯随机效应网络荟萃分析,以结合来自随机对照试验的直接和间接证据。
结果:包含126例患者的5项RCT符合纳入标准。与MMF和CYC相比,TAC和CSA显示出更高的总体缓解率(完全缓解加部分缓解)的趋势。同样,MMF和CYC显示出比皮质类固醇更高的总体反应趋势。基于累积排序曲线下的表面的排序概率表明TAC具有作为实现总体响应的最佳治疗的最高概率。其次是CSA,MMF,CYC,和皮质类固醇。在安全方面,皮质类固醇显示出降低感染风险的最高可能性,其次是CSA,CYC,MMF,和TAC。
结论:TAC和CSA是膜性狼疮性肾炎患者最有效的诱导治疗,糖皮质激素降低感染风险的可能性最高。
BACKGROUND: There were limited data on randomized controlled trials (RCTs) evaluating the effectiveness and safety of tacrolimus (TAC), cyclosporin A (CSA), mycophenolate mofetil (MMF), cyclophosphamide (CYC), and corticosteroids as induction agents in membranous lupus nephritis, and they were inconclusive.
OBJECTIVE: This study aimed to assess the relative efficacy and safety TAC, CSA, MMF, CYC, and corticosteroids as induction therapy for membranous lupus nephritis.
METHODS: RCTs examining the efficacy and safety of TAC, CSA, MMF, CYC, and corticosteroids as induction therapy in patients with membranous lupus nephritis were included. We performed a Bayesian random-effects network meta-analysis to combine direct and indirect evidence from the RCTs.
RESULTS: Five RCTs comprising 126 patients met the inclusion criteria. TAC and CSA showed a trend toward a higher overall response rate (complete remission plus partial remission) than MMF and CYC. Similarly, MMF and CYC showed a trend toward a higher overall response than corticosteroids. Ranking probability based on the surface under the cumulative ranking curve indicated that TAC had the highest probability of being the best treatment for achieving the overall response, followed by CSA, MMF, CYC, and corticosteroids. In terms of safety, corticosteroids showed the highest probability of decreasing the risk of infections, followed by CSA, CYC, MMF, and TAC.
CONCLUSIONS: TAC and CSA were the most efficacious induction treatments for patients with membranous lupus nephritis, and corticosteroids had the highest probability of decreasing the risk of infections.