Among the 4 induction therapies for lupus nephritis (LN), rituximab carries the highest probability of infection and tacrolimus the lowest, according to new study findings.

In a systematic review and network meta-analysis of 19 studies (including 12 randomized controlled trials) published up to December 2021 involving 1566 patients with LN, the maximum surface under the cumulative ranking curve (SUCRA) value for infections was 74.98% for rituximab and the minimum value was 30.17% for tacrolimus, Junjie Gao, MD, and colleagues from Cangzhou Central Hospital, Cangzhou, China, reported in Frontiers in Immunology. Due to limited data, the investigators could not assess the risk of other adverse events, such as gastrointestinal events, myelosuppression, liver damage, alopecia, leukopenia, and menstrual disorders.

With respect to efficacy, rituximab had the highest SUCRA value (96.94%) for complete remission, whereas tacrolimus had the highest value (80.15%) for overall response. Rituximab was associated with 2.6- and 4.2-fold increased odds of complete remission compared with mycophenolate mofetil (MMF) and cyclophosphamide, respectively. MMF was associated with 1.6-fold increased odds of complete remission compared with cyclophosphamide. Cyclophosphamide had the highest SUCRA value (69.47%) for partial remission. Tacrolimus was associated with 3.7-fold increased odds of overall response compared with cyclophosphamide. Among the limitations of the meta-analysis, complete and partial remission were variably defined.

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Dr Gao’s team concluded that rituximab and tacrolimus were “the most effective drugs for inducing remission” among patients with LN, and tacrolimus had the lowest probability of infection.


Li K, Yu Y, Gao Y, Zhao F, Liang Z, Gao J. Comparative effectiveness of rituximab and common induction therapies for lupus nephritis: a systematic review and network meta-analysis. Front Immunol. Published online April 4, 2022. doi:10.3389/fimmu.2022.859380