Mycophenolate Mofetil for Proliferative Lupus Nephritis: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

OU Santao ¹ , ZHONG Lichun ² , DU Xin ¹ ,  HUANG Songmin ¹ , LIU Qi ³ , ZHAO Anju ¹ , CHEN Zejun ¹

1.Department of Nephrology, West China Hospital, Sichuan University, Chengdu 610041, China 2. Department of Gastroenterology, Luzhou Medical College,Luzhou 646000, China 3. Department of Nephrology, Luzhou Medical College, Luzhou 646000, China;

Corresponding author：

HUANG Songmin, Email: hsongm@hotmail.com

Keywords：

Mycophenolate mofetil; Lupus nephritis; Systematic review; Meta-analysis

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Objective　 To assess the effectiveness and safety of mycophenolate mofetil (MMF) in the treatment of proliferative lupus nephritis.
Methods 　We searched CBM (November 1979 to February 2006), Chinese Cochrane Centre Database (2005), The Cochrane Library (Issue 4, 2005), MEDLINE (November 1966 to February 2006) and EMBASE (1975 to February 2006) for randomize controlled trials. Data were extracted and analyzed using The Cochrane Collaboration’s RevMan 4.2.7.
Results 　Nine randomize controlled trials involving 512 patients met the inclusion criteria. The meta-analysis showed that the total clinical effective rate and complete remission rate were not significantly higher for MMF than for cyclophosphamide, azathioprine, or both. Renal survival rate and relapse rate of MMF were not significantly different from those for cyclophosphamide, azathioprine, or both. Patient survival rate and safety of MMF were significantly improved compared with cyclophosphamide, azathioprine, or both.
Conclusion 　More large-scale multi-center randomized trials are needed to investigate the role of MMF in the treatment of proliferative lupus nephritis.

Citation： OU Santao,ZHONG Lichun,DU Xin,HUANG Songmin,LIU Qi,ZHAO Anju,CHEN Zejun. Mycophenolate Mofetil for Proliferative Lupus Nephritis: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2006, 06(10): 712-720. doi: Copy

1.	蒋文功, 肖笑, 方敬爱. 霉酚酸酯治疗弥漫增生性狼疮肾炎的临床观察. 中国中西医结合肾病杂志, 2002; 3(4): 218–221.
2.	刘国平, 黄九香, 林琳. 霉酚酸酯对弥漫增生型狼疮性肾炎患者的疗效观察. 中国中西医结合肾病杂, 2003; 4(7): 386~388.
3.	张江林, 张火亘, 马丽等. 吗替麦考酚酯治疗系统性红斑狼疮的多中心前瞻性研究. 中华风湿病学杂志, 2002; 6(6): 406~410.
4.	朱彬, 周振安, 刘子栋, 等. 霉酚酸酯与环磷酰胺治疗IV型狼疮性肾炎的疗效比较. 山东大学学报 (医学版), 2003; 41(6): 692~694.
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8.	Egger M, Smith GD, Altman DG. Systematic Reviews in Heath Care. London: Tavistock Square, Second edition, 2001. 73-78.
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10.	Cochrane Reviewer’s Handbook 4.2.2. The Cochrane Collaboration, 2000.
11.	Schulz KF, Chalmers I, Hayes RJ. Empirical evidence of bias .JAMA, 1995; 273: 408–412.
12.	Chan TM, Li FK, Tang CS, et al. Efficacy of mycophenolate mofetil in patients with diffuse proliferative lupus nephritis. N Engl J Med, 2000; 343(16): 1156–1162.
13.	Chan TM, Tse KC, Tang CS, et al. Long-term study of mycophenolate mofetil as continuous induction and maintenance treatment for diffuse proliferative lupus nephritis. J Am Soc Nephrol, 2005; 16(4): 1076–1084.
14.	Contreras G, Pardo V, Leclercq B, et al. Sequential therapies for proliferative lupus nephritis. N Engl J Med, 2004; 350(10): 971–980.
15.	Ginzler EM, Dooley MA, Aranow C, et al. Mycophenolate mofetil or intravenous cyclophosphamide for lupus nephritis. N Eng J Med, 2005; 353(21): 2219–2228.
16.	Jiang WG,Xiao X,Fang JA. Eff icacy of Mycophenolate Mofetil in Patients with Diffuse Prol -iferative Lupus Nephritis. Chinese Journal of Integrated Traditional and Western Nephrology, 2002; 3(4): 218–221.
17.	Liu GP, Huang JX, Gui L. Clinical Study of Mycophenolate Mofetil in Patients with Diffuse Proliferative Lupus Nephritis.Chinese Journal of Integrated Traditional and Western Nephrology, 2003; 4(7): 386–388.
18.	Ong LM, Hooi LS, Lim TO, et al. Randomized controlled trial of pulse intravenous cyclophosphamide versus mycophenolate mofetil in the induction therapy of proliferative lupus nephritis. Nephrology, 2005; 10(5): 504–510.
19.	Zhang JL, Zhang HH, Ma L, et al. A multicentric and prospective study on mycophenolate mofetil in the treatment of systemic lupus erythematosus. Chinese Journal of Rheumatology, 2002; 6(6): 406–410.
20.	Zhu B, Zhou ZA, Liu ZD, et al. Comparision of mycophenolate mofetil therapy versus cyclophosphamide treatment of proliferative lupus nephritis. Journal of Shandong Univenity (health sciences), 2003; 41(6): 692–694.

1. 蒋文功, 肖笑, 方敬爱. 霉酚酸酯治疗弥漫增生性狼疮肾炎的临床观察. 中国中西医结合肾病杂志, 2002; 3(4): 218–221.
2. 刘国平, 黄九香, 林琳. 霉酚酸酯对弥漫增生型狼疮性肾炎患者的疗效观察. 中国中西医结合肾病杂, 2003; 4(7): 386~388.
3. 张江林, 张火亘, 马丽等. 吗替麦考酚酯治疗系统性红斑狼疮的多中心前瞻性研究. 中华风湿病学杂志, 2002; 6(6): 406~410.
4. 朱彬, 周振安, 刘子栋, 等. 霉酚酸酯与环磷酰胺治疗IV型狼疮性肾炎的疗效比较. 山东大学学报 (医学版), 2003; 41(6): 692~694.
5. Boumpas DT, Austin HA III, Vaughn EM, et al. Controlled trial of pulse methylprednisolone versus two regimens of pulse cyclophosphamide in severe lupus nephritis.Lancet, 1992; 340: 741–745.
6. Dooley MA, Cosio FG, Nachman PH, et al. Mycophenolate mofetil therapy in lupus nephritis: clinical observations. J Am Soc Nephml, 1999;10(4): 833–839.
7. Tan EM, Cohen AS, Fries JF, et al. The1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum, 1982; 25: 1271–1277.
8. Egger M, Smith GD, Altman DG. Systematic Reviews in Heath Care. London: Tavistock Square, Second edition, 2001. 73-78.
9. Jadad AR ,Moore A ,Carrol D, et al. Assessing the quality of reports of randomized clinical trials: Is blinding necessary. Control Clin Trials, 1996 ; 17: 1–12.
10. Cochrane Reviewer’s Handbook 4.2.2. The Cochrane Collaboration, 2000.
11. Schulz KF, Chalmers I, Hayes RJ. Empirical evidence of bias .JAMA, 1995; 273: 408–412.
12. Chan TM, Li FK, Tang CS, et al. Efficacy of mycophenolate mofetil in patients with diffuse proliferative lupus nephritis. N Engl J Med, 2000; 343(16): 1156–1162.
13. Chan TM, Tse KC, Tang CS, et al. Long-term study of mycophenolate mofetil as continuous induction and maintenance treatment for diffuse proliferative lupus nephritis. J Am Soc Nephrol, 2005; 16(4): 1076–1084.
14. Contreras G, Pardo V, Leclercq B, et al. Sequential therapies for proliferative lupus nephritis. N Engl J Med, 2004; 350(10): 971–980.
15. Ginzler EM, Dooley MA, Aranow C, et al. Mycophenolate mofetil or intravenous cyclophosphamide for lupus nephritis. N Eng J Med, 2005; 353(21): 2219–2228.
16. Jiang WG,Xiao X,Fang JA. Eff icacy of Mycophenolate Mofetil in Patients with Diffuse Prol -iferative Lupus Nephritis. Chinese Journal of Integrated Traditional and Western Nephrology, 2002; 3(4): 218–221.
17. Liu GP, Huang JX, Gui L. Clinical Study of Mycophenolate Mofetil in Patients with Diffuse Proliferative Lupus Nephritis.Chinese Journal of Integrated Traditional and Western Nephrology, 2003; 4(7): 386–388.
18. Ong LM, Hooi LS, Lim TO, et al. Randomized controlled trial of pulse intravenous cyclophosphamide versus mycophenolate mofetil in the induction therapy of proliferative lupus nephritis. Nephrology, 2005; 10(5): 504–510.
19. Zhang JL, Zhang HH, Ma L, et al. A multicentric and prospective study on mycophenolate mofetil in the treatment of systemic lupus erythematosus. Chinese Journal of Rheumatology, 2002; 6(6): 406–410.
20. Zhu B, Zhou ZA, Liu ZD, et al. Comparision of mycophenolate mofetil therapy versus cyclophosphamide treatment of proliferative lupus nephritis. Journal of Shandong Univenity (health sciences), 2003; 41(6): 692–694.

Chinese Journal of Evidence-Based Medicine

Mycophenolate Mofetil for Proliferative Lupus Nephritis: A Systematic Review

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