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Article Open Access

Efficacy of tacrolimus and other immunosuppressants in the treatment of systemic lupus erythematosus: A systematic review and meta‑analysis

  • Authors:
    • Xiaofen Li
    • Juan Zhou
    • Yuan Liu
  • View Affiliations

    Affiliations: Department of Rheumatology, Liuzhou People's Hospital, Liuzhou, Guangxi Zhuang Autonomous Region 545006, P.R. China
  • Published online on: June 23, 2025     https://doi.org/10.3892/br.2025.2023
  • Article Number: 145
  • Copyright: © Li et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

The present systematic review evaluated the efficacy and safety of tacrolimus (TAC) and other immunosuppressants in the treatment of systemic lupus erythematosus (SLE), providing evidence‑based recommendations for clinical practice. PubMed, Web of Science, Embase and Cochrane Library databases were searched for clinical studies comparing TAC with other immunosuppressive drugs. A total of 12 studies, including 10 randomized controlled trials and two cohort studies involving 1,217 patients, were identified. The results indicated that TAC was significantly superior to cyclophosphamide (CYC) in complete remission (CR) rates [odds ratio (OR)=1.83, 95% confidence interval (CI): 1.33‑2.51], whereas no significant differences were found when compared with mycophenolate mofetil [(MMF); OR=0.93; 95% CI: 0.58‑1.47] or azathioprine [(AZA); OR=0.95; 95% CI: 0.49‑1.84]. Thus, significant differences were found in the partial remission rates between TAC and CYC, MMF, or AZA. TAC demonstrated improvements in the short‑term SLE disease activity index scores and albumin levels, with long‑term efficacy comparable to that of MMF and CYC. Furthermore, the infection rate with TAC was lower than that with MMF (OR=0.48; 95% CI: 0.31‑0.75), but similar to those with CYC and AZA. TAC also showed a lower incidence of leukopenia than AZA (OR=0.13; 95% CI: 0.04‑0.43). In conclusion, TAC is superior to CYC in achieving CR in patients with SLE, with comparable efficacy to MMF and AZA. TAC improves short‑term disease activity and albumin levels, and its long‑term efficacy is similar to those of MMF and CYC.
View Figures

Figure 1

Literature screening process.

Figure 2

Bias risk bar chart.

Figure 3

Forest map of the complete response
rate. CYC, cyclophosphamide; AZA, azathioprine; MMF, mycophenolate
mofetil; TAC, tacrolimus.

Figure 4

Forest map of the partial response
rate. CYC, cyclophosphamide; AZA, azathioprine; MMF, mycophenolate
mofetil; TAC, tacrolimus.

Figure 5

Forest map of the infection
incidence. CYC, cyclophosphamide; AZA, azathioprine; MMF,
mycophenolate mofetil; TAC, tacrolimus.

Figure 6

Forest map of leukopenia. CYC,
cyclophosphamide; AZA, azathioprine; MMF, mycophenolate mofetil;
TAC, tacrolimus.

Figure 7

Publication bias assessment. (A)
Funnel plot. (B) Egger’s funnel diagram.
View References

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Copy and paste a formatted citation
Spandidos Publications style
Li X, Zhou J and Liu Y: Efficacy of tacrolimus and other immunosuppressants in the treatment of systemic lupus erythematosus: A systematic review and meta‑analysis. Biomed Rep 23: 145, 2025.
APA
Li, X., Zhou, J., & Liu, Y. (2025). Efficacy of tacrolimus and other immunosuppressants in the treatment of systemic lupus erythematosus: A systematic review and meta‑analysis. Biomedical Reports, 23, 145. https://doi.org/10.3892/br.2025.2023
MLA
Li, X., Zhou, J., Liu, Y."Efficacy of tacrolimus and other immunosuppressants in the treatment of systemic lupus erythematosus: A systematic review and meta‑analysis". Biomedical Reports 23.3 (2025): 145.
Chicago
Li, X., Zhou, J., Liu, Y."Efficacy of tacrolimus and other immunosuppressants in the treatment of systemic lupus erythematosus: A systematic review and meta‑analysis". Biomedical Reports 23, no. 3 (2025): 145. https://doi.org/10.3892/br.2025.2023
Copy and paste a formatted citation
x
Spandidos Publications style
Li X, Zhou J and Liu Y: Efficacy of tacrolimus and other immunosuppressants in the treatment of systemic lupus erythematosus: A systematic review and meta‑analysis. Biomed Rep 23: 145, 2025.
APA
Li, X., Zhou, J., & Liu, Y. (2025). Efficacy of tacrolimus and other immunosuppressants in the treatment of systemic lupus erythematosus: A systematic review and meta‑analysis. Biomedical Reports, 23, 145. https://doi.org/10.3892/br.2025.2023
MLA
Li, X., Zhou, J., Liu, Y."Efficacy of tacrolimus and other immunosuppressants in the treatment of systemic lupus erythematosus: A systematic review and meta‑analysis". Biomedical Reports 23.3 (2025): 145.
Chicago
Li, X., Zhou, J., Liu, Y."Efficacy of tacrolimus and other immunosuppressants in the treatment of systemic lupus erythematosus: A systematic review and meta‑analysis". Biomedical Reports 23, no. 3 (2025): 145. https://doi.org/10.3892/br.2025.2023
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