Systemic lupus erythematosus: lupus nephritis.

Area of Science:

• Nephrology
• Immunology
• Rheumatology

Background:

• Systemic lupus erythematosus (SLE) predominantly affects young women and children globally.
• SLE prevalence varies significantly by region and ethnicity, with higher rates in certain populations like African-American women in the US.

Purpose of the Study:

• To systematically review the effects of immunosuppressants in patients with proliferative lupus nephritis.
• To compare the efficacy and safety of different immunosuppressants, both alone and in combination with corticosteroids, for treating proliferative lupus nephritis.

Main Methods:

• Conducted a systematic overview by searching major databases including Medline, Embase, and The Cochrane Library up to April 2014.
• Screened 120 records, evaluated 67 full publications, and incorporated four systematic reviews and one RCT for analysis.
• Performed a GRADE evaluation for 13 PICO combinations to assess the quality of evidence.

Main Results:

• The review identified and evaluated data on 10 interventions for proliferative lupus nephritis.
• Efficacy was categorized based on comparisons of immunosuppressants plus corticosteroids versus corticosteroids alone.
• Effectiveness and safety of various immunosuppressant combinations were also assessed.

Conclusions:

• The systematic overview provides a categorization of the efficacy of 10 interventions for proliferative lupus nephritis (WHO grades III-V).
• Findings are based on the comparative effectiveness and safety of immunosuppressants and corticosteroids in treating this condition.