Efficacy of tacrolimus plus glucocorticoid for lupus nephritis: a Meta-analysis

Objective Lupus nephritis （LN） is the most common and serious organ involvement in patients with systemic lupus erythematosus. Immunosuppressant therapy can significantly improve the renal function outcome of patients. The purpose of this study is to evaluate the effect of tacrolimus combined with glucocorticoid on LN patients and provide theoretical rationales for managing LN. Methods Such Chinese and English databases as PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure （CNKI）, Wanfang Medical Network and VIP Information Chinese Periodical Service Platform were searched until February 2023. Review Manager and Sata software were employed for system analysis. For continuous variables, standardized mean difference （SMD） and its 95%CI were used. And relative risk （RR） and its 95%CI were employed for binary variables. Cochrane's bias risk tool was utilized for evaluating the bias and risks of eligible studies. Results A total of 12 articles involving 1360 LN patients were finally included. As compared with control group, tacrolimus plus glucocorticoid could significantly improve the partial remission rate （RR value of 1.33, P = 0.02）, effective rate （RR value of 1.28, P＜0.001）, creatinine level （SMD value of −1.12, P = 0.0009） and 24-hour urine protein level （SMD of −1.88, P＜0.001）. And it did not elevate the occurrence of gastrointestinal discomfort, liver dysfunction or infection. Conclusion Tacrolimus plus glucocorticoid therapy helps to improve renal function outcomes of LN patients.