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Lupus Nephritis

What is the most effective induction therapy for membranous lupus nephritis?

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Out of tacrolimus (TAC), cyclosporin A (CSA), mycophenolate mofetil (MMF), cyclophosphamide (CYC), and corticosteroids, TAC and CSA were found to be the most effective induction therapy for patients with membranous lupus nephritis, although corticosteroids were found to be the most likely treatment to decrease the risk of infections, according to a study.

Researchers analyzed 5 randomized controlled trials (RCTs) evaluating the effectiveness and safety of induction therapies in a total of 126 patients.

There was a trend toward a higher overall response rate (complete remission plus partial remission) with TAC and CSA compared with MMF and CYC, while MMF and CYC showed a trend toward a higher overall response than corticosteroids.

TAC demonstrated the highest probability of being the best treatment for achieving the overall response, with CSA, MMF, CYC, and corticosteroids following in that order.

Corticosteroids had the highest probability of decreasing the risk of infections, followed by CSA, CYC, MMF, and TAC.

Reference
Lee YH, Song GG. Comparative Efficacy and Safety of Tacrolimus, Cyclosporin A, Mycophenolate Mofetil, Cyclophosphamide, and Corticosteroids as Induction Therapy for Membranous Lupus Nephritis: A Network Meta-Analysis. Pharmacology. 2022;1-7. doi: 10.1159/000525066. Epub ahead of print. PMID: 35609529.

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