Lupus nephritis treatment: a comprehensive overview of recent meta-analyses and future directions

INTRODUCTION: This review summarizes recent findings from meta-analyses on lupus nephritis (LN) therapies to promote precision medicine and address the challenge of fragmented evidence. METHODS: A literature search identified 34 relevant meta-analyses published between January 2021 and March 2025. RESULTS: Key findings include: Biological agents, particularly Belimumab and Obinutuzumab, significantly improve complete renal remission (CR) and reduce the risk of end-stage renal disease, breaking through traditional therapeutic bottlenecks. However, rituximab, while effective, carries a higher infection risk (SUCRA = 74.98%). The combination of tacrolimus and mycophenolate mofetil doubled the CR rate compared to monotherapy (OR = 2.85), but requires monitoring for creatinine elevation. Voclosporin use is limited by a high infection risk. The combination of Tripterygium glycosides and Western medicine increased the CR rate by 61% (RR = 1.61), while Astragalus-containing Chinese herbal medicine significantly reduced proteinuria (SMD = 0.51), highlighting the value of traditional Chinese medicine in enhancing efficacy and reducing toxicity. Glucocorticoid therapy presents a critical trade-off: an initial dose >60 mg/day improves CR to 34.6% but elevates severe infection and mortality rates to 12.1% and 2.7%, respectively, underscoring the urgent need for dose precision. In diagnostics, urinary TWEAK demonstrates high specificity. Mesenchymal stem cell therapy achieved a 33.7% remission rate. CONCLUSION: In conclusion, this review provides a comprehensive overview of recent research on LN treatment, offering evidence-based support for clinical decision-making and points out directions for future research.