摘要
Abstract
Objective To evaluate the efficacy and safety of long- term using different immunosuppressants combined with glucocorticoids in the treatment of systemic lupus erythematosus nephritis (LN). Methods The databases were retrieved in an orderly manner from the dates of their establishment to February, 2018, including PubMed, The Cochrane Library, Web of Science, CNKI, Wanfang datebase and China Biology Medicine Disc database, to collect randomized controlled trials (RCT) of different immunosuppressants combined with glucocorticoids for LN. Then a network Meta- analysis was conducted using WinBugs 1.4.3 and Stata 12.0 softwares. Results A total of 50 RCTs involving 4 202 patients were included. The Meta-analysis showed that, in the treatment of LN in reducing proteinuria, leflunomide, cyclophosphamide+leflunomide, mycophenolate mofetil, leflunomide+mycophenolate mofetil, cyclophosphamide+Mycophenolate mofetil, tacrolimus+mycophenolate mofetil were superior to cyclophosphamide (P ＜ 0.05), and cyclophosphamide + leflunomide was superior to leflunomide (P ＜ 0.05). The network Meta-analysis also showed that cyclophosphamide+mycophenolate mofetil, leflunomide, leflunomide + mycophenolate mofetil and mycophenolate mofetil were superior to tacrolimus [SMD (95％ CI) respectively: -1.23 (-2.40, -0.04), -1.11 (-2.00, -0.22), -1.44 (-2.79, -0.08), -1.17 (-2.04, -0.29)], and mycophenolate mofetil was superior to cyclophosphamide [SMD (95％ CI): -0.40 (-0.78, -0.01)]. The SUCRA of cyclophosphamide+leflunomide, leflunomide+mycophenolate mofetil and cyclophosphamide+mycophenolate mofetil were respectively 75.3％, 72.7％ and 63.4％. In the treatment of LN in reducing serum creatinine, the Meta-analysis showed that cyclophosphamide+leflunomide, mycophenolate mofetil and cyclophosphamide + mycophenolate mofetil were superior to cyclophosphamide (P ＜ 0.05), and mycophenolate mofetil was superior to cyclophosphamide [SMD (95％ CI): -0.37 (-0.65, -0.09)]. The SUCRA of cyclophosphamide + leflunomide, mycophenolate mofetil and cyclophosphamide + mycophenolate mofetil were respectively 75.9％, 65.1％ and 63.7％. Conclusion The effects of cyclophosphamide + leflunomide and cyclophosphamide + mycophenolatemofetil on LN were superior to other drugs.关键词
狼疮肾炎/多靶点治疗/免疫抑制剂/糖皮质激素/网状Meta分析Key words
lupus nephritis/multi-target treatment/immunosuppressant/glucocorticoids/network Meta-analysis分类
医药卫生
