| Background and Aim:Lupus nephritis(LN)is a common complication of Systemic lupus erythematosus(SLE).Within 5 years after diagnosis of LN,4.3%-10.1% of patients will gradually progress to end-stage renal disease[ 1](end stage renal disease,ESRD).Common clinical treatment options include hormones combined with cyclophosphamide,mycophenolate mofetil,calcineurin inhibitors and so on.Leflunomide(LEF)is an immunomodulator that can suppress the immune response through a variety of mechanisms.In recent years,the research on LEF treatment of LN has gradually increased,but the reports between the studies are different,and the outcomes are quite different.Therefore,this article intends to search the relevant literature of LEF treatment of LN in the database to evaluate the efficacy and safety of LEF treatment of LN patients.Methods:The Cochrane systematic evaluation method was used to search Pub Med,Cochrane Library,Embase,CNKI,Wanfang and VIP databases by computer,and the retrieval time was limited to the establishment of the database until December2020,with no language limitation.Clinical studies comparing LEF with cyclophosphamide(CTX)in the treatment of LN were collected and screened according to inclusion and exclusion criteria.The quality of the included literatures was evaluated and literature information was extracted.Meta-analysis was performed using Rev Man and Stata software.Results:Finally,15 studies that met the requirements of this article were included,with a total of 828 patients,including 411 cases in the LEF group and 417 cases in the CTX group.Compared with the control group,the LEF group improved the complete remission rate(RR=1.27,95%CI[1.03,1.57],P=0.03);the total remission rate(RR=1.11,95%CI[1.02,1.20],P =0.01);reduce urine protein(MD=-0.55,95%CI[-0.99,-0.11],P=0.01);reduce blood creatinine(MD=-5.42,95%CI[-8.38,-2.45],P =0.0003);increase serum albumin(MD=2.85,95%CI[1.24,4.45],P=0.0005);decrease CRP(MD=-8.31,95%CI[-10.73,-5.89],P<0.00001),it is more advantageous to reduce ESR(MD=-18.63,95%CI[-22.16,-15.11],P<0.00001).In the partial remission rate(RR=1.05,95%CI[0.86,1.27],P=0.63);SLEDAI score(MD=-0.28,95%CI[-0.98,0.42],P=0.43);increased C3(MD=0.03,95%CI[-0.02,0.07],P=0.24);reduce anti-ds DNA antibody titer(MD=-2.12,95%CI[-11.10,6.86],P=0.64)among the indicators,LEF There is no significant difference between the group and the control group.The incidence of leukopenia in the LEF group was lower(RR=0.31,95%CI[0.12,0.83],P=0.02),while in the digestive tract symptoms(RR=0.80,95%CI[0.49,1.29],P=0.36);skin rash(RR=0.70,95%CI[0.33,1.47],P=0.34);infection(RR=0.72,95%CI[0.45,1.13],P=0.15);abnormal liver function(RR=0.61,In the comparison of 95%CI[0.35,1.05],P=0.07),there was no significant difference between the LEF group and the CTX group.Conclusion:Leflunomide is effective in reducing urinary protein and improving renal function in patients with LN.The incidence of leukopenia was lower than in the control group. |
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