Tacrolimus May Be A Suitable Choice In The Induction Treatment Of Lupus Nephritis: A Systemic Review And Meta-analysis

Introduction: We conducted a meta-analysis to explore the clinical efficacy and safety of tacrolimus(TAC) on the treatment of lupus nephritis. Methods: We searched the various database. The clinical trails assessing the effect of tacrolimus versus control group on the induction treatment of LN in Asian adult patients, containing renal remission such as complete remission, partial remission and total remission, and side-effects were collected and analyzed. We utilized fixed-effects models in the study. Results: studies involving seven controlled trails and 410 Asian adult patients were included. The complete remission RR=1.18(0.96,1.45), total remission RR=1.12(1.01,1.24) for TAC versus control group; The complete remission RR=0.98(0.77,1.24) for TAC compared with MMF;RR=1.49(1.03,2.17)for TAC compared with CYC; RR=4.89(0.58,41.2)for TAC compared with GCS. The total remission RR=1.07(0.94, 1.22) for TAC compared with MMF; RR=1.21(1.04, 1.42)for TAC compared with CYC. TAC was superior to CYC and GCS for higher kidney remission and had not less favourable remission than MMF. Regarding adverse effects, TAC has less gastrointestinal symptoms, leucopenia and irregular menstruation. TAC has no difference in infection, abnormal liver function and glucose disorder with control group. TAC seemed to cause higher reversible nephrotoxicity. Conclusion: When compared with CYC, TAC seemed to be more effective in remission. When compared with MMF and GCS, TAC seemed be not less favourable remission and less toxic in the treatment of LN in Asian adult patients. However, the information may be useful to demonstrate TAC may be an alternative to traditional medicine for induction treatment of LN in Asian adult patients.