Vergleichende Studie zu Wirksamkeit und Sicherheit von niedrig und hoch dosiertem Cyclophosphamid als Induktionstherapie bei Lupusnephritis: eine Netzwerk-Metaanalyse

Translated title of the contribution: Comparative efficacy and safety of low-dose and high-dose cyclophosphamide as induction therapy for lupus nephritis: a network meta-analysis

S. C. Bae, Young Ho Lee

Research output: Contribution to journalArticle

Abstract

Aim: To assess the relative efficacy and safety of low-dose cyclophosphamide (LCYC) and high-dose CYC (HCYC) as induction therapy for lupus nephritis. Methods: Bayesian random-effects network meta-analysis was performed to combine direct and indirect evidence from randomized controlled trials (RCTs) examining the efficacy and safety of LCYC, HCYC, and mycophenolate mofetil (MMF) for induction therapy in patients with lupus nephritis. Results: Eleven RCTs (1212 patients) were included. MMF and LCYC showed similar overall response rates (OR 1.02, 95% credible interval [CrI] 0.51–2.02), and MMF showed a higher efficacy than HCYC (OR 1.48, 95% CrI 0.99–2.44). Similarly, LCYC showed a higher overall response than HCYC (OR 1.46, 95% CrI 0.83–2.86). Ranking probability based on SUCRA (surface under the cumulative ranking curve) indicated that MMF had the highest probability of being the best treatment for achieving an overall response (SUCRA = 0.7461), followed by LCYC (SUCRA = 0.6978) and HCYC (SUCRA = 0.0561). LCYC showed the highest probability of decreasing the risk of serious infections (SUCRA = 0.8513), followed by MMF (SUCRA = 0.49387) and HCYC (SUCRA = 0.1548). Conclusion: LCYC was an efficacious induction treatment for patients with lupus nephritis and had the highest probability of decreasing the risk of serious infections. Higher response rates and a more favorable safety profile suggest that LCYC is a good option for induction treatment in these patients.

Original languageGerman
JournalZeitschrift fur Rheumatologie
DOIs
Publication statusAccepted/In press - 2018 Jan 1

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Lupus Nephritis
Cyclophosphamide
Meta-Analysis
Mycophenolic Acid
Safety
Therapeutics
Randomized Controlled Trials
Bayes Theorem
Infection

Keywords

  • Cyclophosphamide
  • Euroregimen
  • Lupus nephritis
  • Network meta-analysis
  • NIH regimen

ASJC Scopus subject areas

  • Rheumatology

Cite this

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title = "Vergleichende Studie zu Wirksamkeit und Sicherheit von niedrig und hoch dosiertem Cyclophosphamid als Induktionstherapie bei Lupusnephritis: eine Netzwerk-Metaanalyse",
abstract = "Aim: To assess the relative efficacy and safety of low-dose cyclophosphamide (LCYC) and high-dose CYC (HCYC) as induction therapy for lupus nephritis. Methods: Bayesian random-effects network meta-analysis was performed to combine direct and indirect evidence from randomized controlled trials (RCTs) examining the efficacy and safety of LCYC, HCYC, and mycophenolate mofetil (MMF) for induction therapy in patients with lupus nephritis. Results: Eleven RCTs (1212 patients) were included. MMF and LCYC showed similar overall response rates (OR 1.02, 95{\%} credible interval [CrI] 0.51–2.02), and MMF showed a higher efficacy than HCYC (OR 1.48, 95{\%} CrI 0.99–2.44). Similarly, LCYC showed a higher overall response than HCYC (OR 1.46, 95{\%} CrI 0.83–2.86). Ranking probability based on SUCRA (surface under the cumulative ranking curve) indicated that MMF had the highest probability of being the best treatment for achieving an overall response (SUCRA = 0.7461), followed by LCYC (SUCRA = 0.6978) and HCYC (SUCRA = 0.0561). LCYC showed the highest probability of decreasing the risk of serious infections (SUCRA = 0.8513), followed by MMF (SUCRA = 0.49387) and HCYC (SUCRA = 0.1548). Conclusion: LCYC was an efficacious induction treatment for patients with lupus nephritis and had the highest probability of decreasing the risk of serious infections. Higher response rates and a more favorable safety profile suggest that LCYC is a good option for induction treatment in these patients.",
keywords = "Cyclophosphamide, Euroregimen, Lupus nephritis, Network meta-analysis, NIH regimen",
author = "Bae, {S. C.} and Lee, {Young Ho}",
year = "2018",
month = "1",
day = "1",
doi = "10.1007/s00393-018-0512-8",
language = "German",
journal = "Zeitschrift fur Rheumatologie",
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TY - JOUR

T1 - Vergleichende Studie zu Wirksamkeit und Sicherheit von niedrig und hoch dosiertem Cyclophosphamid als Induktionstherapie bei Lupusnephritis

T2 - eine Netzwerk-Metaanalyse

AU - Bae, S. C.

AU - Lee, Young Ho

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Aim: To assess the relative efficacy and safety of low-dose cyclophosphamide (LCYC) and high-dose CYC (HCYC) as induction therapy for lupus nephritis. Methods: Bayesian random-effects network meta-analysis was performed to combine direct and indirect evidence from randomized controlled trials (RCTs) examining the efficacy and safety of LCYC, HCYC, and mycophenolate mofetil (MMF) for induction therapy in patients with lupus nephritis. Results: Eleven RCTs (1212 patients) were included. MMF and LCYC showed similar overall response rates (OR 1.02, 95% credible interval [CrI] 0.51–2.02), and MMF showed a higher efficacy than HCYC (OR 1.48, 95% CrI 0.99–2.44). Similarly, LCYC showed a higher overall response than HCYC (OR 1.46, 95% CrI 0.83–2.86). Ranking probability based on SUCRA (surface under the cumulative ranking curve) indicated that MMF had the highest probability of being the best treatment for achieving an overall response (SUCRA = 0.7461), followed by LCYC (SUCRA = 0.6978) and HCYC (SUCRA = 0.0561). LCYC showed the highest probability of decreasing the risk of serious infections (SUCRA = 0.8513), followed by MMF (SUCRA = 0.49387) and HCYC (SUCRA = 0.1548). Conclusion: LCYC was an efficacious induction treatment for patients with lupus nephritis and had the highest probability of decreasing the risk of serious infections. Higher response rates and a more favorable safety profile suggest that LCYC is a good option for induction treatment in these patients.

AB - Aim: To assess the relative efficacy and safety of low-dose cyclophosphamide (LCYC) and high-dose CYC (HCYC) as induction therapy for lupus nephritis. Methods: Bayesian random-effects network meta-analysis was performed to combine direct and indirect evidence from randomized controlled trials (RCTs) examining the efficacy and safety of LCYC, HCYC, and mycophenolate mofetil (MMF) for induction therapy in patients with lupus nephritis. Results: Eleven RCTs (1212 patients) were included. MMF and LCYC showed similar overall response rates (OR 1.02, 95% credible interval [CrI] 0.51–2.02), and MMF showed a higher efficacy than HCYC (OR 1.48, 95% CrI 0.99–2.44). Similarly, LCYC showed a higher overall response than HCYC (OR 1.46, 95% CrI 0.83–2.86). Ranking probability based on SUCRA (surface under the cumulative ranking curve) indicated that MMF had the highest probability of being the best treatment for achieving an overall response (SUCRA = 0.7461), followed by LCYC (SUCRA = 0.6978) and HCYC (SUCRA = 0.0561). LCYC showed the highest probability of decreasing the risk of serious infections (SUCRA = 0.8513), followed by MMF (SUCRA = 0.49387) and HCYC (SUCRA = 0.1548). Conclusion: LCYC was an efficacious induction treatment for patients with lupus nephritis and had the highest probability of decreasing the risk of serious infections. Higher response rates and a more favorable safety profile suggest that LCYC is a good option for induction treatment in these patients.

KW - Cyclophosphamide

KW - Euroregimen

KW - Lupus nephritis

KW - Network meta-analysis

KW - NIH regimen

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U2 - 10.1007/s00393-018-0512-8

DO - 10.1007/s00393-018-0512-8

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JO - Zeitschrift fur Rheumatologie

JF - Zeitschrift fur Rheumatologie

SN - 0340-1855

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