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. 2023;108(1):17-26.
doi: 10.1159/000527223. Epub 2022 Nov 3.

Comparative Efficacy and Safety of Biological Agents in the Treatment of Lupus Nephritis: A Network Meta-Analysis

Young Ho Lee  1 , Gwan Gyu Song  1
Affiliations

Comparative Efficacy and Safety of Biological Agents in the Treatment of Lupus Nephritis: A Network Meta-Analysis

Young Ho Lee et al. Pharmacology. 2023.

Abstract

Background: To date, no studies have described randomized controlled trials (RCTs) evaluating the effectiveness and safety of various biological agents used in induction therapy for lupus nephritis.

Objectives: We designed this study to assess the relative efficacy and safety of some of these biological agents in patients with lupus nephritis.

Method: We collected data from RCTs that examined the efficacy and safety of any biological agents for lupus nephritis and then used these data to complete a Bayesian network meta-analysis to combine the direct and indirect evidence from these studies.

Results: We identified nine RCTs evaluating rituximab, abatacept, belimumab, anifrolumab, obinutuzumab, ocrelizumab, and low-dose interleukin-2 (IL-2) across 1,480 patients. Low-dose IL-2, obinutuzumab, rituximab, and belimumab achieved complete remission in a significant proportion of respondents when compared with that in the control. Ranking probability based on the surface under the cumulative ranking curve (SUCRA) indicated that low-dose IL-2 had the highest probability of achieving complete remission, followed by obinutuzumab, rituximab, belimumab, anifrolumab, abatacept, ocrelizumab, and the control. The risk of serious adverse events (SAE) tended to be lower for low-dose IL-2, rituximab, belimumab, and obinutuzumab than for the control. SUCRA-based ranking indicated that IL-2 had the highest probability of being safe, followed by rituximab, belimumab, obinutuzumab, control, anifrolumab, abatacept, and ocrelizumab.

Conclusions: Low-dose IL-2 was the most effective induction treatment for patients with lupus nephritis and had the lowest potential for SAE. Higher complete remission rates and a more favorable safety profile suggest that low-dose IL-2, obinutuzumab, rituximab, and belimumab may be superior to the current control as treatments for lupus nephritis.

Keywords: Biological agent; Lupus nephritis; Network meta-analysis.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Bayesian network meta-analysis results of various randomized controlled studies evaluating the relative efficacy of biological agents for complete remission in lupus nephritis.
Fig. 2
Fig. 2
Bayesian network meta-analysis results for various randomized controlled studies describing the relative safety and incidence of serious adverse reactions in response to different biological agents during the treatment of lupus nephritis.
See this image and copyright information in PMC

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