PMID- 24369416
OWN - NLM
STAT- MEDLINE
DCOM- 20140617
LR  - 20181202
IS  - 1462-0332 (Electronic)
IS  - 1462-0324 (Linking)
VI  - 53
IP  - 5
DP  - 2014 May
TI  - Maintenance therapy of lupus nephritis with mycophenolate or azathioprine: 
      systematic review and meta-analysis.
PG  - 834-8
LID - 10.1093/rheumatology/ket429 [doi]
AB  - OBJECTIVE: The objective of this study was to summarize the comparative efficacy 
      and safety of MMF and AZA as maintenance therapy for LN. METHODS: Systematic 
      review and meta-analysis of randomized clinical trials of MMF and AZA as 
      maintenance therapy for LN were performed based on a sensitive search. 
      Meta-regression was used to explore causes of heterogeneity. Safety was explored 
      using crude and combined incidence rate ratios (IRRs) of the more frequent 
      adverse events (AEs). RESULTS: The search produced 7341 hits. Four randomized 
      clinical trials and one long-term study were selected for detailed analysis. No 
      significant differences between MMF and AZA were found in sustained remission, 
      relapse, renal failure, creatinine increase or death. However, there was high 
      heterogeneity in the design of studies, drug doses and treatment in the previous 
      induction phase. Significant lower rates of discontinuation due to AEs occurred 
      in the MMF group, with a relative risk (RR) of 0.60 (95% CI 0.41, 0.88) but 
      significant risk of publication bias (Egger test, P = 0.012). Gastrointestinal 
      manifestations were more common [combined IRR 1.68 (95% CI 1.06, 2.68)] and 
      leucopoenia less frequent in the MMF group [combined IRR 0.14 (95% CI 0.05, 
      0.42)]. CONCLUSION: The available data does not support the superiority of MMF or 
      AZA as maintenance therapy for LN. Nevertheless, the high heterogeneity of 
      studies included in the analysis makes this contention questionable.
FAU - Maneiro, Jose R
AU  - Maneiro JR
AD  - Rheumatology Department, Complejo Hospitalario Universitario de Santiago de 
      Compostela, c/ Travesia da Choupana s/n, 15701 Santiago de Compostela, Spain. 
      joseramon.maneiro.fernandez@sergas.es.
FAU - Lopez-Canoa, Nicolas
AU  - Lopez-Canoa N
FAU - Salgado, Eva
AU  - Salgado E
FAU - Gomez-Reino, Juan J
AU  - Gomez-Reino JJ
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20131224
PL  - England
TA  - Rheumatology (Oxford)
JT  - Rheumatology (Oxford, England)
JID - 100883501
RN  - HU9DX48N0T (Mycophenolic Acid)
RN  - MRK240IY2L (Azathioprine)
SB  - IM
MH  - Adult
MH  - Azathioprine/adverse effects/*therapeutic use
MH  - Disease Management
MH  - Humans
MH  - Lupus Nephritis/*drug therapy
MH  - Mycophenolic Acid/adverse effects/*analogs & derivatives/therapeutic use
MH  - Randomized Controlled Trials as Topic
MH  - Treatment Outcome
OTO - NOTNLM
OT  - azathioprine
OT  - lupus nephritis
OT  - mycophenolate mofetil
EDAT- 2013/12/27 06:00
MHDA- 2014/06/18 06:00
CRDT- 2013/12/27 06:00
PHST- 2013/12/27 06:00 [entrez]
PHST- 2013/12/27 06:00 [pubmed]
PHST- 2014/06/18 06:00 [medline]
AID - ket429 [pii]
AID - 10.1093/rheumatology/ket429 [doi]
PST - ppublish
SO  - Rheumatology (Oxford). 2014 May;53(5):834-8. doi: 10.1093/rheumatology/ket429. 
      Epub 2013 Dec 24.