Micofenolato o tacrolimus comparado con ciclofosfamida en el tratamiento de nefritis lúpica: revisión sistemática y metaanálisis

Abstract

Objective: To perform a meta-analysis of controlled clinical trials to compare response rates of complete response and partial remission rates, as well as the adverse effects of immunosuppressive treatments, such as mycophenolate (MF) and tacrolimus, compared with cyclophosphamide (CY), for the management of lupus nephritis.

Materials and methods: Clinical trials were identified through MEDLINE database using Pub- Med, OVID and Cochrane search engines, LILACS, EMBASE, New York Academy of Medicine and conference proceedings from the ACR, EULAR, and GLADEL. Data were extracted independently by 2 reviewers.

Results: For the comparison betweenMFand CY, 9 clinical trialswere obtained, with a total of 812 patients, showing that MF has similar efficacy with CY in terms of complete and partial remission. There was no significant difference in gastrointestinal symptoms, leukopenia or deaths. There is less risk of menstrual abnormalities (RR: 0.38, 95% CI: 0.20-0.73), infections (RR: 0.64; 95% CI: 0.45-0.91) and less risk of hair loss (RR: 0.25, 95% CI: 0.16-0.38) in the MF group. For the comparison between tacrolimus and CY, 3 clinical trials were obtained, with a total 146 patients, showing that tacrolimus and CY have similar efficacy in complete and partial remission. In the outcome response (complete and partial remission), it was found that tacrolimus had a greater benefit than CY (RR: 1.21, 95% CI: 1.02-1.45). There was no significant difference in terms of toxicity between tacrolimus and CY.

Conclusions: Patients treated with MF, tacrolimus and CY have similar rates of remission; however there is greater benefit in outcome response when comparing tacrolimus and CY. Comparing MF with CY showed a lower risk of menstrual abnormalities and reduced risk of alopecia.