Meta-analysis Of Tacrolimus In The Treatment Of Lupus Nephritis

Objective: To evaluate the clinical efficacy and safety of tacrolimus and cyclophosphamide(CTX)on lupus nephritis. Methods: Such databases as Pubmed,The Cochrane Library, Ovid, Wanfang, VIP, CNKI, Chaoxing, Sinomed, CSCD were electronically searched for comprehensively collecting randomized controlled trials(RCTs)on the effectiveness and safety of tacrolimus and cyclophosphamide for lupus nephritis from inception to September 2015.Language was limited Chinese and English only.Two reviewers independently screened literature according to the inclusion and exclusion criteria,extracted data,and assessed the methodological quality of included studies.Then,meta-analysis was performed using RevMan 5.2 software.Results: Totally,twelve RCTs involving 558 patients were included. The results of Meta-analysis showed that,tacrolimus group got better complete remission ratio(P=0.0002),effective rate(P=0.0001),reducing 24 hour urinary protein levels(P=0.0004), reducing the time needed for partial response(P=0.0002)of six month. Tacrolimus group can obtain good curative effect in enhancing the level of serum albumin of 6 months and 9 months(P<0.00001)(P=0.002).The difference was statistically significant. Side effects such as gastrointestinal discomfort, menstrual disorders and bone marrow suppression in tacrolimus group were lower than those in CTX group of 6 months. There were no significant differences between tacrolimus group and CTX group in the incidence of complete remission ratio(P=0.07),effective rate(P=0.12),24 hour urinary protein levels(P=0.14)of 9 months. There were no significant differences between tacrolimus group and CTX group in the incidence of infection(P=0.07),abnormal glucose metabolism(P=0.12),high blood pressure(P=0.09),liver function impairment(P=0.05),renal impairment(P=0.44)of 6 months. Conclusion: Existing evidence suggests that, tacrolimus can have certain advantages than CTX group in the treatment of lupus nephritis in theshort term.But due to the quality and quantity of the study is limited, and lack of long-term follow-up of the evidence, reduces the intensity of the system evaluation of evidence, the conclusion of this evaluation system is only for reference for clinical practice and research.