A Systematic Review Of Tacrolimus For Lupus Nephritis

Objective: to evaluate the effect and safety of the inductive treatment for adult patientswith lupus nephritis through combination of glucocorticoid with tacrolimus(TAC).Methods: The studies were base on searched Cochrane library, Pubmed,OVID, ChinaNational Knowledge Infrastructure (CNKI),Wanfang database inquiring related documentsin self before December,2013and manually searched references cited in the paper at thesame time.Chose respective randomized controlled trial or controlled clinical trail against theinductive treatment for adult patients with lupus nephritis through combination ofglucocorticoid with tacrolimus. Search key words” tacrolimus/FK506,Lupus Nephritis/LN/Lupus glomerulosclerosis, randomized clinical trials”. Evaluated the quality of thedocuments involved in the research according to Jadad scoring method. Did Meta analysisthrough RevMan5.1.Results:10randomized controlled trail and1prospective cohort study which involvedin504patients were included.251of the patients were samples for the combination ofglucocorticoid and tacrolimus, and218were for glucocorticoid and cyclophosphamide, andthe rest35were for glucocorticoid and placebo. Evaluate publications bias of efficacy andsafety by the funnel map which made by Rev Man5.1software. The position of spots wasnearly symmetric on the funnel map,which prove that there was small publication bias in theincluded studies. The analysis result showed that the time get part remission in TAC group issignificant shorter than CTX group.When analysing the efficiency, the studies after6monthtreatment were divided into two subgroups according to whether pathologic types were typeIV, the result showed: the complete remission rate of the TAC group were much higher thanthe control group in IV type LN[OR=2.23，95%CI（1.08,4.63），P=0.03], but the responserate(P=0.05)、decrease of the urine protein(P=0.20)、improve of serum albumin(P=0.72) andSLE-DAI(P=0.09) were similar to control group in the same pathologic type. All theoutcomes in the other pathlogic types show significant advantagement after6month treatment in the TAC group than control group(P<0.001). And all suvery in the3monthshow that obvious obvious advantagement in TAC group in every pathlogic types(P<0.05).In the drug-relate adverse aspect, the analysis result reveal that glucose intolerance washigher than control group (P<0.05), but similar with CTX group(P=0.05).The incidence ofinfection, nephrotoxicity, gastrointestinal reaction,elevated blood pressure, was similar withcontrol group (P>0.05), and the incidence of hepatotoxicity,decline of WBC, menstruldisorder were lower than conreol group(P<0.05).Conclusion： Tacrolimus can control constitutional symptoms of SLE and lupusnephritis with different pathologic types especially non-IV type LN or complex LN rapidlyand effectively. There are81.48%patients got clinical remission at3month after inductiontreatment. The adverse of glucose intolerance was higher than control group. The incidenceof drug-related adverse events,such as hepatotoxicity, nephrotoxicity, reproductive toxicity,infection, gastrointestinal reaction, decline of WBC and elevated blood pressure, was similarto CTX group or lower.