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Metanalysis of nine clinical trials and 972 lupus patients examined the comparative efficacy of tacrolimus, mycophenolate (MMF) and cyclophosphamide (CYC) as induction therapy for lupus nephritis. Pairwise comparisons were performed, including 11 direct comparisons (Citation source http://buff.ly/1U1wchB).
The response rate with tacrolimus was significantly higher than with CYC (OR 2.35, 95% CI 1.03-5.45). The overall response rate was higher, though not statistically significantly so, with MMF compared with CYC (OR 1.45, 95% CI 0.96-2.42). Tacrolimus was most efficacious as induction treatment for patients with lupus nephritis, and had the highest probability of decreasing the risk of serious infections. Higher remission rates combined with a more favorable safety profile suggest that MMF is superior to CYC as induction treatment in these patients.