Comparison of Different Usage of Cyclophosphamide in Lupus Nephritis: A Meta-analysis of Randomized Controlled Trails

BACKGROUND: The present study aims to compare the relative efficacy and safety of different usage of cyclophosphamide (CYC) in lupus nephritis (LN). METHODS: We searched the Cochrane Library, EMBASE, Global Health, MEDLINE and PubMed for articles from the building of the database to June 2018. RESULTS: 12 randomized controlled trials with 994 participants were included. The meta-analysis indicated that the short-interval lower-dose intravenous CYC regime remarkably reduced 24-hour proteinuria [mean difference (MD) -0.45; 95% confidence interval (CI) -0.62 to -0.27; I2 0%], incidence of major infections [odds ratio (OR) 0.62, 95% CI 0.40 to 0.95; I2 42%], gonadal toxicity (OR 0.41, 95% CI 0.27 to 0.62; I2 0%), and leukopenia (OR 0.55, 95% CI 0.33 to 0.94, I2 0%), while high-dose regime had an obvious lower probability of doubling of serum creatinine (Scr) level (OR 2.43; 95% CI 1.19 to 4.95; I2 0%). Besides, the difference in complete and total remission rates between the two regimens was not observed. CONCLUSION: The result suggested that the short-interval lower-dose CYC regime remarkably reduced 24-hour proteinuria and the incidence of adverse events, while long-course high-dose regime played significant role in reducing the rate of doubling Scr level.