The Efficacy Of Calcineurin Inhibitors Combined With Glucocorticoid In The Treatment Of Lupus Nephritis:A Meta-Analysis

Objective:To systematically evaluate the efficacy of calcineurin inhibitors combined with glucocorticoid in the treatment of lupus nephritis Methods:All randomized controlled trials(RCTs)that focus on the efficacy of calcineurin inhibitors combined with glucocorticoid in the treatment of lupus nephritis were screened from CNKI、VIP、WanFang、CBM、Pubmed、OVID、Embase、Cochrane library clinical controlled trials database.Data were extracted by two independents researchers,and the control of quality was evaluated from the modified Jadad rating scale.Meta analysis was then undertaken through RevMan 5.3 software.Results:A total of 10 RCTs were obtained,included 621 patients with lupus nephritis.Patients were divided into calcineurin inhibitors combined with glucocorticoid group(n=309)and control group(n=312).Meta-analysis results showed that(1)the effects of calcineurin inhibitors combined with glucocorticoid were significantly better than those of control group including total remission(OR=1.87,95%CI:1.07~3.27,P=0.03)、 systemic lupus erythematosus disease activity index score(OR=-1.57,95%CI:-2.23~-0.91,P<0.0001)、24 hours proteinuria(MD=-0.25,95%CI:-0.39~-0.11,P=0.0005)、 serum albumin(MD=2.95,95% CI:0.90~5.00,P=0.005)、 serum creatinine(MD=-16.44,95%CI:-26.12~-6.77,P=0.0009).(2)the rates of side effects of calcineurin inhibitors combined with glucocorticoid were not higher than those of control group including leukopenia(OR=0.18,95%CI:0.07~0.50,P=0.0009)、herpes zoster(OR=0.18,95%CI:0.06~0.52,P=0.001)、 pulmonary(OR=0.72,95%CI:0.41~1.25,P=0.24)、gastrointestinal symptoms(OR=0.60,95%CI:0.31~1.15,P=0.12)、diabetes(OR=2.00,95%CI:0.88~4.54,P=0.10).Conclusions:The current clinical evidence showed that calcineurin inhibitors combined with glucocorticoid have a better effect on the treatment of patients with lupus nephritis.However,large scale,multicenter,well designed clinical trials should be adopted to further confirm the conclusions.