PMID- 29644081
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220409
IS  - 2053-8790 (Print)
IS  - 2053-8790 (Electronic)
IS  - 2053-8790 (Linking)
VI  - 5
IP  - 1
DP  - 2018
TI  - Risk of adverse events from different drugs for SLE: a systematic review and 
      network meta-analysis.
PG  - e000253
LID - 10.1136/lupus-2017-000253 [doi]
LID - e000253
AB  - OBJECTIVE: The comparative safety of immunosuppressive drugs, biologicals and 
      glucocorticoids (GC) for patients with SLE remains controversial. We aimed to 
      investigate the specific side effects of the available SLE drugs in this 
      population of patients. METHODS: Electronic databases were systematically 
      searched through September 2017 for randomised trials in patients with SLE. The 
      primary outcomes were all-cause mortality and withdrawal related to adverse 
      events (AEs). We performed a random-effects network meta-analysis to obtain 
      estimates for primary and secondary outcomes and presented these estimates as ORs 
      with 95% CIs. RESULTS: Forty-four studies comprising 9898 participants were 
      included in the network meta-analysis. No drug regimen was considered to be safer 
      for reducing all-cause mortality. However, compared with cyclophosphamide, 
      azathioprine (OR 3.04, 95% CI (1.44 to 6.42)) and cyclosporine (OR 3.28, 95% CI 
      (1.04 to 10.35)) were significantly less safety in AE-related withdrawals, and GC 
      was ranked lowest and led to higher withdrawal rates. Tacrolimus (TAC) was ranked 
      high and showed a benefit in many outcomes. Biologicals and chloroquine also 
      showed good safety in all of the available outcomes, while the beneficial effects 
      of other immunosuppressive drugs were not substantial in different types of 
      serious adverse events. CONCLUSIONS: TAC is the safest strategy for patients with 
      SLE. Biologicals and chloroquine are also fairly safe for patients with SLE. The 
      use of other immunosuppressive drugs and GC needs to be balanced against the 
      potential harms of different types of AEs, and the practical safety of drug 
      combinations still requires further trials to evaluate.
FAU - Tian, Jingru
AU  - Tian J
AD  - Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The 
      Second Xiangya Hospital, Central South University, Changsha, China.
FAU - Luo, Yien
AU  - Luo Y
AD  - Xiangya School of Medicine, Central South University, Changsha, China.
FAU - Wu, Haijing
AU  - Wu H
AD  - Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The 
      Second Xiangya Hospital, Central South University, Changsha, China.
FAU - Long, Hai
AU  - Long H
AD  - Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The 
      Second Xiangya Hospital, Central South University, Changsha, China.
FAU - Zhao, Ming
AU  - Zhao M
AD  - Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The 
      Second Xiangya Hospital, Central South University, Changsha, China.
FAU - Lu, Qianjin
AU  - Lu Q
AD  - Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The 
      Second Xiangya Hospital, Central South University, Changsha, China.
LA  - eng
PT  - Journal Article
DEP - 20180309
PL  - England
TA  - Lupus Sci Med
JT  - Lupus science & medicine
JID - 101633705
PMC - PMC5890859
OTO - NOTNLM
OT  - adverse events
OT  - dmards (biologic)
OT  - safety
OT  - systemic lupus erythematosus
OT  - treatment
COIS- Competing interests: None declared.
EDAT- 2018/04/13 06:00
MHDA- 2018/04/13 06:01
PMCR- 2018/03/09
CRDT- 2018/04/13 06:00
PHST- 2017/12/02 00:00 [received]
PHST- 2018/02/01 00:00 [revised]
PHST- 2018/02/16 00:00 [accepted]
PHST- 2018/04/13 06:00 [entrez]
PHST- 2018/04/13 06:00 [pubmed]
PHST- 2018/04/13 06:01 [medline]
PHST- 2018/03/09 00:00 [pmc-release]
AID - lupus-2017-000253 [pii]
AID - 10.1136/lupus-2017-000253 [doi]
PST - epublish
SO  - Lupus Sci Med. 2018 Mar 9;5(1):e000253. doi: 10.1136/lupus-2017-000253. 
      eCollection 2018.