Table 6.
Efficacy of different therapeutic agents in refractory/non-responding or flaring LN
| Reference | Type of study | n | Intervention | Control | Endpoint | Results | Risk of bias* | |
|---|---|---|---|---|---|---|---|---|
| CY | ||||||||
| Anutrakulchai et al 91 | RCT | CY:32 EC-MPS: 27 |
CY + P | EC-MPS + P | 12 m CR, PR, TF | CR+PR: CY vs EC-MPS 68% vs 71%, p = ns TF: CY vs EC-MPS 46.9% vs 37%, p = ns Premature termination due to high rate of serious adverse events in CY arm |
High | |
| Moroni et al 92 | Observational | CY:14 RTX:10 | PO CY + P | RTX + P | 3y CR | CR: CY vs RTX 92% vs 80% | 7 | |
| Multitarget | ||||||||
| Choi et al 93 | Observational | 29 | MMF + TAC + P | - | 12 m CR, PR | CR: 25.9% PR: 29.6% |
4 | |
| Mok et al 94 | Observational | 21 | MMF + TAC + P | - | 12 m CR, PR | CR+PR: 67% | 5 | |
| Kasitanon et al 95 | Observational | 21 | MMF + CsA + P add-on to IS | - | 12 m CR, PR | CR: 33.3% PR: 38.1% |
5 | |
| RTX | ||||||||
| Zhang et al 96 | RCT | 84 (1:1) | CY + RTX + P | CY + P | 12 m CR, PR | CR+ PR: CY vs RTX+CY 57.1% vs 83.3% p < 0.05 | High | |
| Kotagiri et al 97 | Observational | 14 | RTX + p add-on to IS | - | 18 m CR, PR, Relapse | CR+PR: 79% Relapse: 45% |
4 | |
| Davies et al 98 | Observational | 18 | RTX + CY + P | - | 12 m CR, PR, Relapse | CR+PR: 72% Relapse: 39% |
5 | |
| Jonsdottir et al 99 | Observational | 25 | RTX + CY + P | - | 36 m CR, PR, Relapse | CR: 64% PR: 88% Relapse: 24% |
6 | |
| Iaccarino et al 100 | Observational | 68 | RTX + P± CY | - | 12 m CR, PR, Relapse | CR+PR: 94.1% Relapse: 29.4% |
6 | |
| Contis et al 101 | Observational | 17 | RTX + P | - | 52 w CR, PR | CR+PR: 53% | 4 | |
| MMF | ||||||||
| Rivera et al 102 | Observational | 85 | MMF + P | - | 60 m CR, PR, Relapse | CR: 27% PR: 60% Relapse: 15.7% |
5 | |
*Overall risk of bias was assessed using the Revised Cochrane risk-of-bias tool (ROB2) for RCT and the Newcastle-Ottawa scale for observational studies.
CY, cyclophosphamide; CR, complete response; CsA, ciclosporin A; EC-MPS, enteric-coated mycophenolate sodium; IS, immunosuppressant; m, months; MMF, mycophenolate mofetil; P, prednisone; PR, partial response; RCT, randomised controlled trial; RTX, rituximab; TF, treatment failure; TAC, tacrolimus; w, weeks; y, years.