Maintenance therapy for lupus nephritis with mycophenolate mofetil or azathioprine. A meta-analysis

Maintenance therapy for lupus nephritis (LN) remains controversial. This meta-analysis of randomized controlled trials (RCTs) describes the comparative benefits and safety of mycophenolate mofetil (MMF) versus azathioprine (AZA) as maintenance therapy in patients with LN. RCTs that compared the maintenance regimens of MMF and AZA in the treatment of LN were included. Outcomes were mortality, end-stage renal disease (ESRD), renal relapse, doubling of serum creatinine, and adverse effects. We performed the meta-analysis using Review Manager software (version 5.3). Seven RCTs were included in the meta-analysis. There were no significant differences between the MMF and AZA groups in regards to mortality, relapse, ESRD, doubling of serum creatinine, infection, or gastrointestinal upset. However, the MMF group incurred lower risks of leukopenia (RR = 0.16, 95% CI = 0.06 - 0.40; p = 0.0001) and amenorrhea (RR = 0.23, 95% CI = 0.09 - 0.59, p = 0.002) compared with the AZA group. MMF seems more effective than AZA as maintenance therapy for LN although the differences did not reach statistical significance. Furthermore, the MMF group incurred lower risk of leukopenia than AZA. However, more RCTs are needed to confirm the conclusion.