Comparison of Different Usage of Cyclophosphamide in Lupus Nephritis: A Meta-analysis of Randomized Controlled Trails.

Abstract

BACKGROUND\nThe present study aims to compare the relative efficacy and safety of different usage of cyclophosphamide (CYC) in lupus nephritis (LN).\n\n\nMETHODS\nWe searched the Cochrane Library, EMBASE, Global Health, MEDLINE and PubMed for articles from the building of the database to June 2018.\n\n\nRESULTS\n12 randomized controlled trials with 994 participants were included. The meta-analysis indicated that the short-interval lower-dose intravenous CYC regime remarkably reduced 24-hour proteinuria [mean difference (MD) -0.45; 95% confidence interval (CI) -0.62 to -0.27; I2 0%], incidence of major infections [odds ratio (OR) 0.62, 95% CI 0.40 to 0.95; I2 42%], gonadal toxicity (OR 0.41, 95% CI 0.27 to 0.62; I2 0%), and leukopenia (OR 0.55, 95% CI 0.33 to 0.94, I2 0%), while high-dose regime had an obvious lower probability of doubling of serum creatinine (Scr) level (OR 2.43; 95% CI 1.19 to 4.95; I2 0%). Besides, the difference in complete and total remission rates between the two regimens was not observed.\n\n\nCONCLUSION\nThe result suggested that the short-interval lower-dose CYC regime remarkably reduced 24-hour proteinuria and the incidence of adverse events, while long-course high-dose regime played significant role in reducing the rate of doubling Scr level.