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Abstract: FR-PO1111

Mycophenolate Mofetil in the Treatment of Chinese Patients with Active Lupus Nephritis: A Systematic Review and Meta-Analysis

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Zhou, Minlin, National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu, China
  • Zhao, Hongxin, Shanghai Roche Pharmaceuticals Ltd., Shanghai, China
  • Zhu, Yuxian, Shanghai Roche Pharmaceuticals Ltd., Shanghai, China
  • Wang, Xin, Shanghai Roche Pharmaceuticals Ltd., Shanghai, China
  • Zhang, Haitao, National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu, China
Background

Mycophenolate mofetil (MMF) has been recommended as induction and maintenance therapy for lupus nephritis (LN). MMF has shown superiority over cyclophosphamide (CYC) in LN patients of Hispanic or mixed race. So far, there has been no comprehensive review of the efficacy and safety of MMF in the treatment of LN that focused on Chinese patients. Thus, the present study aims to investigate the efficacy and safety of MMF in the treatment of Chinese patients with LN.

Methods

The following databases were searched: PubMed and EMBASE (from January 1979–January 2018); and the Cochrane Collaboration, China National Knowledge Infrastructure, Wanfang, and SinoMed (in January 2018). The search strategies comprised: (mycophenolate mofetil AND (cyclophosphamide OR azathioprine)) AND (lupus nephritis OR lupus glomerulonephritis OR proliferative glomerulonephritis OR membranous glomerulonephritis OR systemic lupus erythematosus) in English and in Chinese. Two reviewers independently assessed each identified clinical trial. Meta-analysis was conducted by using RevMan5.3 software.

Results

A total of 12 eligible randomized controlled trials (RCTs; 5 English and 7 Chinese articles; total 557 patients) were included. Nine RCTs reported complete remission (CR). The complete remission rate was significantly higher in the MMF group (48.9%) than in the CYC group (37.4%) (relative risk [RR] 1.28; 95% confidence interval [CI]: 1.05, 1.55; p=0.01). There was no significant difference in the total remission rate between the two groups of induction therapy (TR [CR + partial remission]; RR 1.11; 95% CI: 0.97, 1.26; p=0.12). MMF versus CYC during induction therapy was associated with significantly lower risks of infection (RR 0.58; 95% CI: 0.41, 0.84; p=0.004), leukopenia (RR 0.26; 95% CI: 0.11, 0.66; p=0.004), alopecia (RR 0.12; 95% CI: 0.03, 0.43; p=0.001), and amenorrhea (RR 0.15; 95% CI: 0.04, 0.56; p=0.004). No significant difference in relapse rate was evident between the MMF and AZA groups (RR 1.15; 95% CI: 0.59, 2.26; p=0.68).

Conclusion

MMF for induction treatment of lupus nephritis in China is superior to CYC in complete remission and is safer.

Funding

  • Commercial Support