Original Article Mycophenolate mofetil in induction and maintenance therapy of severe lupus nephritis: a meta-analysis of randomized controlled trials

Background. The outcomes of previous trials of mycophenolate mofetil (MMF) in treating severe lupus nephritis (LN) are not in exact agreement. This meta-analysis of randomized controlled trials (RCTs) assesses the benefits and harms of MMF in the induction and maintenance therapy of severe LN. Methods. We searched Medline, EMBASE and the Cochrane Collaboration Database for RCTs that compared MMF with other immunorepressive regi-mens for treating lupus nephritis and extracted data for remissions, side effects and prognosis in induction therapy and prognosis and side effects in maintenance therapy, and we summarized the combined results of the data of the RCTs as relative risk (RR). Results. We analysed five RCTs with 307 patients— four RCTS providing the data for comparing MMF with cyclophosphamide (CYC) for induction therapy and two RCTs providing the data for comparing MMF with azathioprine (AZA) for maintenance therapy of severe LN. Overall, compared with CYC, induction therapy with MMF reduced the risk of infection significantly (RR 0.65, P< 0.001). It also significantly increased the complete remission rate compared with intravenous CYC (RR 3.10, P 0.006). Compared with intravenous CYC, induc-tion therapy with MMF reduced the incidence o