Immunosuppressive Treatment for Proliferative Lupus Nephritis

This review update assessed various immunosuppressive treatments for proliferative lupus nephritis, involving 74 studies with 5175 participants. The evidence suggested that mycophenolate mofetil (MMF) might increase complete disease remission compared to intravenous cyclophosphamide, with fewer cases of alopecia but more diarrhea. However, the certainty of this evidence was low, and the effects on death, end-stage kidney disease (ESKD), and major infections were uncertain. Combining MMF with tacrolimus might further improve remission rates, though safety profiles remain unclear. For maintenance therapy, azathioprine likely increased disease relapse compared to MMF. Overall, the studies were not designed to assess death or ESKD outcomes, and the evidence certainty varied from low to very low.