Efficacy and Safety of Mizoribine in the Treatment of Lupus Nephritis: A Systematic Review and Meta-Analysis

INTRODUCTION: This study evalöuated the clinical efficacy and safety of mizoribine (MZR) in the treatment of lupus nephritis. METHODS: ≥ 25% and P ≤ 0.1). Prespecified subgroup analyses were performed by treatment duration (induction period ≤ 6 months vs. maintenance period > 6 months) and control regimen (glucocorticoid group vs. glucocorticoid and immunosuppressants ). RESULTS: Nineteen studies (four RCTs, one cohort, 14 single-arm) with 1489 patients were included. Meta-analysis of randomized controlled trials (RCTs) showed no significant differences in renal response rates or adverse reaction rates between MZR and control groups, but a higher SLEDAI score was observed with MZR (WMD = 1.75, 95% CI 0.33-3.16, P < 0.05). Subgroup analysis indicated MZR was associated with a reduced renal response rates (RR = 0.83, 95% CI 0.71-0.97, P < 0.05), elevated proteinuria (WMD = 0.62, 95% CI 0.22-1.03, P < 0.05), and higher SLEDAI scores (WMD = 1.75, 95% CI 0.33-3.16, P < 0.05) versus controls. These negative outcomes, including increased proteinuria (WMD = 0.73, 95% CI 0.11-1.36, P < 0.05) and SLEDAI (WMD = 2.60, 95% CI 1.19-4.01, P < 0.05), were significant only in the induction period use (P < 0.05) and not sustained maintenance period (> 6 months). Single-arm studies reported high response rates (59-100%) but widely variable adverse reaction rates (5-50%). The types of adverse events included hyperuricemia, respiratory tract infection, leukopenia, etc. CONCLUSIONS: Mizoribine demonstrates phased efficacy in lupus nephritis: it is less effective than standard regimens for the induction period (≤ 6 months) but comparable during the maintenance period (> 6 months). Therefore, it is not a first-line induction agent but serves as a practical maintenance option, particularly for patients intolerant of conventional therapies or in resource-limited settings.