9-扶异内部培训2010选编.ppt

* A total of 268 patients were included in the four RCT, 133 of whom were treated with MMF and 135 of whom were treated with cyclophosphamide (Table 1). The mean age of patients ranged from 28 to 42 yr, with most patients of female gender (range 79 to 94%). The most common ethnic group was Asian (42%), followed by black (30%). Baseline mean (SD) serum creatinine measurements ranged from 93.3 (46.0) to 112.7 (65.8) μmol/L in the MMF group and from 94.0 (40.2) to 113.1 (36.9) μmol/L in the cyclophosphamide group; baseline mean (SD) proteinuria ranged from 1.8 (1.2) to 6.2 (4.1) g/24 h in the MMF group and from 3.0 (1.8) to 4.4 (3.6) g/24 h in the cyclophosphamide group. A total of 238 patients had proliferative lupus nephritis (World Health Organization [WHO] class III/IV), and 30 patients showed pure membranous lupus nephritis (WHO class V). All trials used adjunctive therapy with corticosteroids. One RCT used oral cyclophosphamide as a comparator (18), and three RCT compared MMF with intravenous cyclophosphamide (13,14,19). Dosing of MMF varied across studies, ranging from 1 to 3 g/d. * Three of the four studies that were included in the meta-analysis showed no significant difference between MMF and cyclophosphamide for the RR for failure to induce remission (14,18,19), whereas one study showed a significant reduction in the RR for failure to induce remission in patients who received MMF (13). The pooled RR for failure to induce remission for MMF compared with cyclophosphamide, using a fixed-effects model, was 0.70 (95% CI 0.54 to 0.90; P = 0.004), suggesting a significant treatment benefit for MMF (Figure 2). The Q statistic did not detect significant heterogeneity between trials (P = 0.76). Because of the lack of heterogeneity, a random-effects model was done only as a sensitivity analysis and did not differ significantly from the fixed-effects model. Figure 1. Kaplan-Meier Estimates of Patient Survival. Membranous features were noted in seven and five patients