Abstract: SA-PO0849
Network Meta-Analysis of Triple Immunosuppressive Therapies and Standard of Care for Induction of Remission of Active Lupus Nephritis
Session Information
- Glomerular Diseases: Management, Evolving Strategies, and Practice-Changing Advances
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Contreras, Gabriel, University of Miami Miller School of Medicine, Miami, Florida, United States
- Mechery, Vinodh, University of Miami Miller School of Medicine, Miami, Florida, United States
- Kota, Sanjana, University of Miami Miller School of Medicine, Miami, Florida, United States
- Del Castillo Rix, Daniel Sebastian, University of Miami Miller School of Medicine, Miami, Florida, United States
- Bandes, Miguel Antonio, University of Miami Miller School of Medicine, Miami, Florida, United States
- Dejman, Adriana, University of Miami Miller School of Medicine, Miami, Florida, United States
- Zuo, Yiqin, University of Miami Miller School of Medicine, Miami, Florida, United States
- Duque, Juan, University of Miami Miller School of Medicine, Miami, Florida, United States
- Munoz Mendoza, Jair, University of Miami Miller School of Medicine, Miami, Florida, United States
Background
In patients with active lupus nephritis (LN), 8 triple immunosuppressive therapies (TITs) have been compared to the standard of care (SOC) of double immunosuppressive therapy in 12 induction randomized clinical trials. Direct comparisons of SOC+Tacrolimus, SOC+Voclosporin, SOC+Belimumab, and SOC+Obinutuzumab compared to SOC alone demonstrated significantly higher remission of LN without excessive risk of serious adverse events (SAEs). Direct or indirect comparisons among TITs have not been studied.
Methods
In this network meta-analysis (NMA), we provide indirect comparisons of the relative efficacy and safety of TITs, ranking them from the best to the worst therapy achieving primary renal remission (PRR) of LN and reducing the risk of SAEs.
Results
Patients who received SOC+Tacrolimus had significantly higher PRR compared to SOC+Rituximab (benefit ratio 2.30 [95% Credible interval 1.27-4.20]), SOC+Anifrolumab (1.98 [1.07-3.52]), SOC+Ocrelizumab (1.81 [1.12-2.82]), and SOC+Abatacept (1.78 [1.07-2.91]) (Table). SOC+Voclosporin had significantly higher PRR compared to SOC+Rituximab (2.03 [1.14-2.68]). SOC+Tacrolimus (SUCRA=95.12%) ranked as the best therapy inducing PRR. Risk ratios of SAE were not significantly different among the TITs. SOC+Rituximab (SUCRA=84.85%) ranked as the safest therapies lowering the relative risk of SAE.
Conclusion
Triple Induction therapies of SOC with calcineurin inhibitors had the highest relative benefit achieving remission of LN. SOC+Rituximab had the lowest relative risk of SAEs.
Relative benefit ratios with 95% credible intervals of the primary efficacy outcome of primary renal remission in lower triangle (column compared to row as reference) and the relative risk ratios with 95% credible intervals of the primary safety outcome of serious adverse event in upper triangle (row compared to column as reference)
| SOC+ Tacrolimus | 1.53 (0.62-3.99) | 1.34 (0.53-3.63) | 2.10 (0.85-5.51) | 1.84 (0.74-4.79) | 1.71 (0.68-4.54) | 1.56 (0.50-5.00) | 1.79 (0.76-4.51) | 2.27 (0.87-6.32) |
| 1.13 (0.77-1.66) | SOC+ Voclosporin | 0.88 (0.55-1.39) | 1.37 (0.89-2.11) | 1.20 (0.78-1.86) | 1.12 (0.70-1.77) | 1.03 (0.43-2.21) | 1.17 (0.86-1.59) | 1.48 (0.88-2.54) |
| 1.35 (0.92-2.00) | 1.20 (0.82-1.75) | SOC+ Obinutuzumab | 1.56 (0.99-2.46) | 1.37 (0.88-2.14) | 1.27 (0.77-2.06) | 1.17 (0.49-2.58) | 1.33 (0.95-1.87) | 1.69 (0.99-2.94) |
| 1.44 (1.00-2.12) | 1.28 (0.90-1.85) | 1.07 (0.75-1.54) | SOC+ Belimumab | 0.88 (0.57-1.33) | 0.82 (0.51-1.28) | 0.75 (0.32-1.61) | 0.85 (0.63-1.15) | 1.08 (0.64-1.84) |
| 1.78 (1.07-2.91) Φ | 1.57 (0.96-2.56) | 1.31 (0.80-2.12) | 1.23 (0.76-1.97) | SOC+ Abatacept | 0.93 (0.58-1.46) | 0.86 (0.36-1.85) | 0.97 (0.73-1.31) | 1.23 (0.74-2.09) |
| 1.81 (1.12-2.82) Φ | 1.60 (1.00-2.50) | 1.34 (0.84-2.07) | 1.25 (0.79-1.93) | 1.02 (0.58-1.75) | SOC+ Ocrelizumab | 0.92 (0.39-2.03) | 1.04 (0.75-1.50) | 1.33 (0.77-2.34) |
| 1.98 (1.07-3.52) Φ | 1.75 (0.95-3.10) | 1.47 (0.79-2.57) | 1.37 (0.74-2.37) | 1.11 (0.56-2.13) | 1.10 (0.56-2.05) | SOC+ Anifrolumab | 1.14 (0.56-2.56) | 1.45 (0.63-3.64) |
| 1.91 (1.45-2.56) Φ | 1.69 (1.30-2.23) Φ | 1.41 (1.09-1.84) Φ | 1.32 (1.04-1.69) Φ | 1.08 (0.72-1.64) | 1.06 (0.74-1.56) | 0.97 (0.59-1.68) | SOC | 1.27 (0.84-1.96) |
| 2.30 (1.27-4.20) Φ | 2.03 (1.14-2.68) Φ | 1.69 (0.95-3.05) | 1.59 (0.90-2.83) | 1.29 (0.67-2.53) | 1.27 (0.68-2.42) | 1.16 (0.57-2.46) | 1.20 (0.72-2.04) | SOC+ Rituximab |
Φ significant difference of benefit ratios.