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TAC-TIC use of tacrolimus-based regimens in lupus nephritis
  1. Tineke Kraaij1,2,
  2. Obbo W Bredewold1,2,
  3. Stella Trompet3,4,
  4. Tom W J Huizinga2,5,
  5. Ton J Rabelink1,2,
  6. Anton J M de Craen3, and
  7. Y K Onno Teng1,2
  1. 1Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
  2. 2Clinic for Lupus-, Vasculitis and Complement-Mediated Systemic Diseases, Leiden University Medical Center, Leiden, The Netherlands
  3. 3Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
  4. 4Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
  5. 5Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
  1. Correspondence to Dr Y K Onno Teng; y.k.o.teng{at}lumc.nl

Abstract

Current guidelines do not mention tacrolimus (TAC) as a treatment option and no consensus has been reported on the role of TAC in lupus nephritis (LN). The present study aimed to guide clinical judgement on the use of TAC in patients with LN. A meta-analysis was performed for clinical studies investigating TAC regimens in LN on the basis of treatment target (induction or maintenance), concomitant immunosuppression and quality of the data. 23 clinical studies performed in patients with LN were identified: 6 case series, 9 cohort studies, 2 case-control studies and 6 randomised controlled trials (RCTs). Of the 6 RCTs, 5 RCTs investigated TAC regimens as induction treatment and 1 RCT as maintenance treatment. Five RCTs investigated TAC in combination with steroids and 2 TAC with mycophenolate plus steroids. All RCTs were performed in patients of Asian ethnicity. In a meta-analysis, TAC regimens achieved a significantly higher total response (relative risk (RR) 1.23, 95% CI 1.12 to 1.34, p<0.05) and significantly higher complete response (RR 1.48, 95% CI 1.23 to 1.77, p<0.05). The positive outcome was predominantly defined by the largest RCT investigating TAC with mycophenolate plus steroids. Regarding safety, the occurrence of leucopoenia was significantly lower, while the occurrence of increased creatine was higher. Clinical studies on TAC regimens for LN are limited to patients of Asian ethnicity and hampered by significant heterogeneity. The positive results on clinical efficacy of TAC as induction treatment in LN cannot be extrapolated beyond Asian patients with LN. Therefore, further confirmation in multiethnic, randomised trials is mandatory. Until then, TAC can be considered in selected patients with LN.

  • Lupus Nephritis
  • Systemic Lupus Erythematosus
  • Autoimmune Diseases

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Dr Craen died on January 17th, 2016.

  • Contributors TK, TJR, YKOT contributed to the ideas for the article. YKOT performed the literature search. TK, AJMC, ST and YKOT contributed to data acquisition and analysis. TK, OWB, ST, TWJH, TJR and YKOT contributed to the writing of the manuscript. YKOT is the guarantor.

  • Funding The work of TK and YKOT was supported by the Dutch Kidney Foundation (KJPB12.028) and a Clinical Fellowship by the Dutch Organisation for Scientific Research.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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