Efficacy and Safety of Low-Dose Cyclophosphamide vs Mycophenolatemofetil in Patients with Lupus Nephritis: A Systemic Review andMeta-Analysis

Abstract

Background: Lupus Nephritis is still the most leading cause of morbidity
and mortality in SLE (Systemic Lupus Erythematosus). Low-dose CYC
(Cyclophosphamide) regimen was effective and had a higher safety profile
than standard CYC regimen. MMF (Mycophenolate Mofetil), a selective
lymphocyte antiproliferative agent, has been shown in several studies to be
a safe and effective substitute to full dose CYC. The objective of this metaanalysis

was to compare the efficacy and safety of these low-dose CYC vs
MMF subjects with LN (Lupus Nephritis). Methods: The authors
systematically searched CENTRAL, PubMed, and ScienceDirect from 2009
to early 2024. Studies enrolled RCT (Randomized Controlled Trial), in which
patients diagnosed with lupus nephritis were treated with low-dose
intravenous CYC or oral MMF. Results: A total of 6 trials, including 787
patients, were included in this meta-analysis. The analysis showed there is
no different between low dose-CYC MMF and MMF. (RR 0.96 95% CI [0.96,
1.27], p = 0.76, Tau2 = 0.00, Chi2 = 0.07, df =1 and I2 = 0%, p = 0.79).
Conclusion: No significant difference was observed between the two
treatment regimens. Oral MMF was associated in increasing vomiting and
alopecia rather than low-dose CYC. Both agents demonstrated modest
efficacy. However, further research is required to definitively assess the
relative effectiveness and safety in a large patient cohort.