Spandidos Publications Logo
  • About
    • About Spandidos
    • Aims and Scopes
    • Abstracting and Indexing
    • Editorial Policies
    • Reprints and Permissions
    • Job Opportunities
    • Terms and Conditions
    • Contact
  • Journals
    • All Journals
    • Oncology Letters
      • Oncology Letters
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Oncology
      • International Journal of Oncology
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Molecular and Clinical Oncology
      • Molecular and Clinical Oncology
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Experimental and Therapeutic Medicine
      • Experimental and Therapeutic Medicine
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Molecular Medicine
      • International Journal of Molecular Medicine
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Biomedical Reports
      • Biomedical Reports
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Oncology Reports
      • Oncology Reports
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Molecular Medicine Reports
      • Molecular Medicine Reports
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • World Academy of Sciences Journal
      • World Academy of Sciences Journal
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Functional Nutrition
      • International Journal of Functional Nutrition
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Epigenetics
      • International Journal of Epigenetics
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Medicine International
      • Medicine International
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
  • Articles
  • Information
    • Information for Authors
    • Information for Reviewers
    • Information for Librarians
    • Information for Advertisers
    • Conferences
  • Language Editing
Spandidos Publications Logo
  • About
    • About Spandidos
    • Aims and Scopes
    • Abstracting and Indexing
    • Editorial Policies
    • Reprints and Permissions
    • Job Opportunities
    • Terms and Conditions
    • Contact
  • Journals
    • All Journals
    • Biomedical Reports
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Experimental and Therapeutic Medicine
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Epigenetics
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Functional Nutrition
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Molecular Medicine
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Oncology
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Medicine International
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Molecular and Clinical Oncology
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Molecular Medicine Reports
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Oncology Letters
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Oncology Reports
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • World Academy of Sciences Journal
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
  • Articles
  • Information
    • For Authors
    • For Reviewers
    • For Librarians
    • For Advertisers
    • Conferences
  • Language Editing
Login Register Submit
  • This site uses cookies
  • You can change your cookie settings at any time by following the instructions in our Cookie Policy. To find out more, you may read our Privacy Policy.

    I agree
Search articles by DOI, keyword, author or affiliation
Search
Advanced Search
presentation
Experimental and Therapeutic Medicine
Join Editorial Board Propose a Special Issue
Print ISSN: 1792-0981 Online ISSN: 1792-1015
Journal Cover
June-2014 Volume 7 Issue 6

Full Size Image

Sign up for eToc alerts
Recommend to Library

Journals

International Journal of Molecular Medicine

International Journal of Molecular Medicine

International Journal of Molecular Medicine is an international journal devoted to molecular mechanisms of human disease.

International Journal of Oncology

International Journal of Oncology

International Journal of Oncology is an international journal devoted to oncology research and cancer treatment.

Molecular Medicine Reports

Molecular Medicine Reports

Covers molecular medicine topics such as pharmacology, pathology, genetics, neuroscience, infectious diseases, molecular cardiology, and molecular surgery.

Oncology Reports

Oncology Reports

Oncology Reports is an international journal devoted to fundamental and applied research in Oncology.

Experimental and Therapeutic Medicine

Experimental and Therapeutic Medicine

Experimental and Therapeutic Medicine is an international journal devoted to laboratory and clinical medicine.

Oncology Letters

Oncology Letters

Oncology Letters is an international journal devoted to Experimental and Clinical Oncology.

Biomedical Reports

Biomedical Reports

Explores a wide range of biological and medical fields, including pharmacology, genetics, microbiology, neuroscience, and molecular cardiology.

Molecular and Clinical Oncology

Molecular and Clinical Oncology

International journal addressing all aspects of oncology research, from tumorigenesis and oncogenes to chemotherapy and metastasis.

World Academy of Sciences Journal

World Academy of Sciences Journal

Multidisciplinary open-access journal spanning biochemistry, genetics, neuroscience, environmental health, and synthetic biology.

International Journal of Functional Nutrition

International Journal of Functional Nutrition

Open-access journal combining biochemistry, pharmacology, immunology, and genetics to advance health through functional nutrition.

International Journal of Epigenetics

International Journal of Epigenetics

Publishes open-access research on using epigenetics to advance understanding and treatment of human disease.

Medicine International

Medicine International

An International Open Access Journal Devoted to General Medicine.

Journal Cover
June-2014 Volume 7 Issue 6

Full Size Image

Sign up for eToc alerts
Recommend to Library

  • Article
  • Citations
    • Cite This Article
    • Download Citation
    • Create Citation Alert
    • Remove Citation Alert
    • Cited By
  • Similar Articles
    • Related Articles (in Spandidos Publications)
    • Similar Articles (Google Scholar)
    • Similar Articles (PubMed)
  • Download PDF
  • Download XML
  • View XML
Article

Calcineurin inhibitors may be a reasonable alternative to cyclophosphamide in the induction treatment of active lupus nephritis: A systematic review and meta-analysis

  • Authors:
    • Min Yang
    • Min Li
    • Wei He
    • Bin Wang
    • Yong Gu
  • View Affiliations / Copyright

    Affiliations: Department of Nephrology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu 213000, P.R. China, Department of Gastroenterology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu 213000, P.R. China, Division of Nephrology, Huashan Hospital and Institute of Nephrology, Fudan University, Shanghai 200040, P.R. China
  • Pages: 1663-1670
    |
    Published online on: April 7, 2014
       https://doi.org/10.3892/etm.2014.1669
  • Expand metrics +
Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )
Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )
Cited By (CrossRef): 0 citations Loading Articles...

This article is mentioned in:



Abstract

Although the accepted standard of care during the induction treatment of active lupus nephritis (LN) has been cyclophosphamide (CYC), recent trials suggest that calcineurin inhibitors (CNIs), which include cyclosporine A (CsA) and tacrolimus (TAC), may be just as, or even more, effective and less toxic than CYC. A systematic review and meta-analysis were performed to evaluate the clinical effects of CNIs on active LN compared with those of CYC. In the present study, clinical trials that compared CNIs with CYC in the induction therapy of active LN were searched in the Cochrane Library, Ovid and PubMed databases. The clinical data on renal remission and side-effects were collected and analyzed. The relative risk (RR) and 95% confidence intervals (CIs) were calculated. As a result, six controlled trials involving 265 patients were included in the meta-analysis, four of which compared TAC (treatment group) with CYC (control group), and the other two compared CsA (treatment group) with CYC (control group). CNIs were superior to CYC for higher complete remission (RR=1.56, 95% CI 1.14‑2.15, Z=2.74, P=0.006) and better overall response/total remission (RR=1.23, 95% CI 1.07‑1.42, Z=2.87, P=0.004) and had fewer side‑effects. Among the CNIs, TAC demonstrated more favorable results than CsA. Therefore, it was concluded that CNIs may be a reasonable alternative to CYC in the induction treatment of active LN. However, large-scale, multicenter, well-designed clinical trials should be adopted to further confirm this conclusion.
View Figures

Figure 1

Figure 2

Figure 3

View References

1 

Cervera R, Khamashta MA, Font J, et al; The European Working Party on Systemic Lupus Erythematosus. Systemic lupus erythematosus: clinical and immunologic patterns of disease expression in a cohort of 1,000 patients. Medicine (Baltimore). 72:113–124. 1993. View Article : Google Scholar : PubMed/NCBI

2 

Mok CC and Tang SS: Incidence and predictors of renal disease in Chinese patients with systemic lupus erythematosus. Am J Med. 117:791–795. 2004. View Article : Google Scholar : PubMed/NCBI

3 

Austin HA III, Klippel JH, Balow JE, et al: Therapy of lupus nephritis. Controlled trial of prednisone and cytotoxic drugs. N Engl J Med. 314:614–619. 1986.PubMed/NCBI

4 

Carette S, Klippel JH, Decker JL, et al: Controlled studies of oral immunosuppressive drugs in lupus nephritis. A long-term follow-up. Ann Intern Med. 99:1–8. 1983. View Article : Google Scholar : PubMed/NCBI

5 

Boumpas DT, Austin HA III, Vaughn EM, et al: Controlled trial of pulse methylprednisolone versus two regimens of pulse cyclophosphamide in severe lupus nephritis. Lancet. 340:741–745. 1992. View Article : Google Scholar : PubMed/NCBI

6 

Mok CC, Wong RW and Lai KN: Treatment of severe proliferative lupus nephritis: the current state. Ann Rheum Dis. 62:799–804. 2003. View Article : Google Scholar : PubMed/NCBI

7 

Bhat P and Radhakrishnan J: B lymphocytes and lupus nephritis: new insights into pathogenesis and targeted therapies. Kidney Int. 73:261–268. 2008. View Article : Google Scholar : PubMed/NCBI

8 

Sommerer C, Giese T, Meuer S and Zeier M: New concepts to individualize calcineurin inhibitor therapy in renal allograft recipients. Saudi J Kidney Dis Transpl. 21:1030–1037. 2010.PubMed/NCBI

9 

Chen W, Tang X, Liu Q, et al: Short-term outcomes of induction therapy with tacrolimus versus cyclophosphamide for active lupus nephritis: A multicenter randomized clinical trial. Am J Kidney Dis. 57:235–244. 2011. View Article : Google Scholar : PubMed/NCBI

10 

Wang S, Li X, Qu L, et al: Tacrolimus versus cyclophosphamide as treatment for diffuse proliferative or membranous lupus nephritis: a non-randomized prospective cohort study. Lupus. 21:1025–1035. 2012. View Article : Google Scholar : PubMed/NCBI

11 

Li X, Ren H, Zhang Q, et al: Mycophenolate mofetil or tacrolimus compared with intravenous cyclophosphamide in the induction treatment for active lupus nephritis. Nephrol Dial Transplant. 27:1467–1472. 2012. View Article : Google Scholar : PubMed/NCBI

12 

Szeto CC, Kwan BC, Lai FM, et al: Tacrolimus for the treatment of systemic lupus erythematosus with pure class V nephritis. Rheumatology (Oxford). 47:1678–1681. 2008. View Article : Google Scholar : PubMed/NCBI

13 

Zavada J, Pesickova S, Rysava R, et al: Cyclosporine A or intravenous cyclophosphamide for lupus nephritis: the Cyclofa-Lune study. Lupus. 19:1281–1289. 2010. View Article : Google Scholar : PubMed/NCBI

14 

Austin HA III, Illei GG, Braun MJ and Balow JE: Randomized, controlled trial of prednisone, cyclophosphamide, and cyclosporine in lupus membranous nephropathy. J Am Soc Nephrol. 20:901–911. 2009. View Article : Google Scholar : PubMed/NCBI

15 

Jadad AR, Moore RA, Carroll D, et al: Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 17:1–12. 1996. View Article : Google Scholar

16 

Moher D, Pham B, Jones A, et al: Does quality of reports of randomised trials affect estimates of intervention efficacy reported in meta-analyses? Lancet. 352:609–613. 1998. View Article : Google Scholar : PubMed/NCBI

17 

Kjaergard LL, Villumsen J and Gluud C: Reported methodologic quality and discrepancies between large and small randomized trials in meta-analyses. Ann Intern Med. 135:982–989. 2001. View Article : Google Scholar

18 

Oremus M, Oremus C, Hall GB and McKinnon MC: Inter-rater and test-retest reliability of quality assessments by novice student raters using the Jadad and Newcastle-Ottawa Scales. BMJ Open. 2:e0013682012. View Article : Google Scholar

19 

Higgins JP and Thompson SG: Quantifying heterogeneity in a meta-analysis. Stat Med. 21:1539–1558. 2002. View Article : Google Scholar : PubMed/NCBI

20 

Miyasaka N, Kawai S and Hashimoto H: Efficacy and safety of tacrolimus for lupus nephritis: a placebo-controlled double-blind multicenter study. Mod Rheumatol. 19:606–615. 2009. View Article : Google Scholar : PubMed/NCBI

21 

Yap DY, Yu X, Chen XM, et al: Pilot 24 month study to compare mycophenolate mofetil and tacrolimus in the treatment of membranous lupus nephritis with nephrotic syndrome. Nephrology (Carlton). 17:352–357. 2012. View Article : Google Scholar : PubMed/NCBI

22 

Bao H, Liu ZH, Xie HL, Hu WX, Zhang HT and Li LS: Successful treatment of class V+IV lupus nephritis with multitarget therapy. J Am Soc Nephrol. 19:2001–2010. 2008.

23 

Valeri A, Radhakrishnan J, Estes D, et al: Intravenous pulse cyclophosphamide treatment of severe lupus nephritis: a prospective five-year study. Clin Nephrol. 42:71–78. 1994.PubMed/NCBI

24 

Mok CC, Ho CT, Siu YP, et al: Treatment of diffuse proliferative lupus glomerulonephritis: a comparison of two cyclophosphamide-containing regimens. Am J Kidney Dis. 38:256–264. 2001. View Article : Google Scholar : PubMed/NCBI

25 

Sesso R, Monteiro M, Sato E, Kirsztajn G, Silva L and Ajzen H: A controlled trial of pulse cyclophosphamide versus pulse methylprednisolone in severe lupus nephritis. Lupus. 3:107–112. 1994. View Article : Google Scholar : PubMed/NCBI

26 

Belmont HM, Storch M, Buyon J and Abramson S: New York University/Hospital for Joint Diseases experience with intravenous cyclophosphamide treatment: efficacy in steroid unresponsive lupus nephritis. Lupus. 4:104–108. 1995. View Article : Google Scholar

27 

Dooley MA and Ginzler EM: Newer therapeutic approaches for systemic lupus erythematosus: immunosuppressive agents. Rheum Dis Clin North Am. 32:91–102. 2006. View Article : Google Scholar : PubMed/NCBI

28 

Scott LJ, McKeage K, Keam SJ and Plosker GL: Tacrolimus: a further update of its use in the management of organ transplantation. Drugs. 63:1247–1297. 2003. View Article : Google Scholar : PubMed/NCBI

29 

Lee YH, Lee HS, Choi SJ, Dai Ji J and Song GG: Efficacy and safety of tacrolimus therapy for lupus nephritis: a systematic review of clinical trials. Lupus. 20:636–640. 2011. View Article : Google Scholar : PubMed/NCBI

30 

Deng J, Huo D, Wu Q, Yang Z and Liao Y: A meta-analysis of randomized controlled trials comparing tacrolimus with intravenous cyclophosphamide in the induction treatment for lupus nephritis. Tohoku J Exp Med. 227:281–288. 2012. View Article : Google Scholar

31 

Midgette AS, Wong JB, Beshansky JR, Porath A, Fleming C and Pauker SG: Cost-effectiveness of streptokinase for acute myocardial infarction: A combined meta-analysis and decision analysis of the effects of infarct location and of likelihood of infarction. Med Decis Making. 14:108–117. 1994. View Article : Google Scholar : PubMed/NCBI

32 

Jones T and Evans D: Conducting a systematic review. Aust Crit Care. 13:66–71. 2000. View Article : Google Scholar

33 

Flather MD, Farkouh ME, Pogue JM and Yusuf S: Strengths and limitations of meta-analysis: larger studies may be more reliable. Control Clin Trials. 18:568–579; discussion 661–666. 1997. View Article : Google Scholar : PubMed/NCBI

34 

Alarcón GS, Friedman AW, Straaton KV, et al: Systemic lupus erythematosus in three ethnic groups: III. A comparison of characteristics early in the natural history of the LUMINA cohort LUpus in MInority populations: NAture vs Nurture. Lupus. 8:197–209. 1999.

35 

Cooper GS, Parks CG, Treadwell EL, et al: Differences by race, sex and age in the clinical and immunologic features of recently diagnosed systemic lupus erythematosus patients in the southeastern United States. Lupus. 11:161–167. 2002. View Article : Google Scholar : PubMed/NCBI

36 

Moroni G, Doria A and Ponticelli C: Cyclosporine (CsA) in lupus nephritis: assessing the evidence. Nephrol Dial Transplant. 24:15–20. 2009. View Article : Google Scholar : PubMed/NCBI

37 

Favre H, Miescher PA, Huang YP, Chatelanat F and Mihatsch MJ: Ciclosporin in the treatment of lupus nephritis. Am J Nephrol. 9(Suppl 1): 57–60. 1989. View Article : Google Scholar

38 

Chen W, Liu Q, Chen W, et al: Outcomes of maintenance therapy with tacrolimus versus azathioprine for active lupus nephritis: a multicenter randomized clinical trial. Lupus. 21:944–952. 2012. View Article : Google Scholar : PubMed/NCBI

Related Articles

  • Abstract
  • View
  • Download
  • Twitter
Copy and paste a formatted citation
Spandidos Publications style
Yang M, Li M, He W, Wang B and Gu Y: Calcineurin inhibitors may be a reasonable alternative to cyclophosphamide in the induction treatment of active lupus nephritis: A systematic review and meta-analysis. Exp Ther Med 7: 1663-1670, 2014.
APA
Yang, M., Li, M., He, W., Wang, B., & Gu, Y. (2014). Calcineurin inhibitors may be a reasonable alternative to cyclophosphamide in the induction treatment of active lupus nephritis: A systematic review and meta-analysis. Experimental and Therapeutic Medicine, 7, 1663-1670. https://doi.org/10.3892/etm.2014.1669
MLA
Yang, M., Li, M., He, W., Wang, B., Gu, Y."Calcineurin inhibitors may be a reasonable alternative to cyclophosphamide in the induction treatment of active lupus nephritis: A systematic review and meta-analysis". Experimental and Therapeutic Medicine 7.6 (2014): 1663-1670.
Chicago
Yang, M., Li, M., He, W., Wang, B., Gu, Y."Calcineurin inhibitors may be a reasonable alternative to cyclophosphamide in the induction treatment of active lupus nephritis: A systematic review and meta-analysis". Experimental and Therapeutic Medicine 7, no. 6 (2014): 1663-1670. https://doi.org/10.3892/etm.2014.1669
Copy and paste a formatted citation
x
Spandidos Publications style
Yang M, Li M, He W, Wang B and Gu Y: Calcineurin inhibitors may be a reasonable alternative to cyclophosphamide in the induction treatment of active lupus nephritis: A systematic review and meta-analysis. Exp Ther Med 7: 1663-1670, 2014.
APA
Yang, M., Li, M., He, W., Wang, B., & Gu, Y. (2014). Calcineurin inhibitors may be a reasonable alternative to cyclophosphamide in the induction treatment of active lupus nephritis: A systematic review and meta-analysis. Experimental and Therapeutic Medicine, 7, 1663-1670. https://doi.org/10.3892/etm.2014.1669
MLA
Yang, M., Li, M., He, W., Wang, B., Gu, Y."Calcineurin inhibitors may be a reasonable alternative to cyclophosphamide in the induction treatment of active lupus nephritis: A systematic review and meta-analysis". Experimental and Therapeutic Medicine 7.6 (2014): 1663-1670.
Chicago
Yang, M., Li, M., He, W., Wang, B., Gu, Y."Calcineurin inhibitors may be a reasonable alternative to cyclophosphamide in the induction treatment of active lupus nephritis: A systematic review and meta-analysis". Experimental and Therapeutic Medicine 7, no. 6 (2014): 1663-1670. https://doi.org/10.3892/etm.2014.1669
Follow us
  • Twitter
  • LinkedIn
  • Facebook
About
  • Spandidos Publications
  • Careers
  • Cookie Policy
  • Privacy Policy
How can we help?
  • Help
  • Live Chat
  • Contact
  • Email to our Support Team