The following is a summary of “Efficacy and Safety of Biologic Agents for Lupus Nephritis: A Systematic Review and Meta-analysis,” published in the March 2023 issue of Rheumatology by Chen, et al.

For a study, researchers sought to evaluate the efficacy and safety of biological agents for treating lupus nephritis (LN).

To achieve this, they thoroughly searched the PubMed, EMBASE, and Cochrane Library databases from inception until November 2021. The outcomes of interest included overall response, complete remission, proteinuria, renal activity index, and adverse events (AEs). The inclusion criteria required only randomized controlled trials (RCTs).

In the study, nine randomized controlled trials (RCTs) were conducted, involving a total of 1,645 patients who received various biological agents, including abatacept (n=2), belimumab (n=1), obinutuzumab (n=1), atacicept (n=1), IL-2 (n=1), ocrelizumab (n=1), and rituximab (n=2). The use of biological agents was found to be associated with an increased likelihood of achieving an overall response (relative risk [RR], 1.26; 95% CI, 1.15–1.39; P<0.001; I² = 14.3%; p_Q = 0.301) and a complete response (RR, 1.33; 95% CI, 1.16–1.54; P<0.001; I² = 41.8%; p_Q = 0.056). 

However, using biological agents did not improve the urinary protein-to-creatinine ratio (weighted mean difference, 3.83; 95% CI, −3.71 to 11.38; P=0.319; I² = 99.4%; p_Q < 0.001). The use of biological agents in patients with LN was not associated with an increased risk of any adverse events (AEs) (RR, 1.01; 95% CI, 0.98–1.04; P = 0.519; I² = 0.0%; p_Q = 0.533), such as serious AEs (RR, 0.95; 95% CI, 0.82–1.09; P=0.457; I² = 0.0%; p_Q = 0.667), grade >3 AEs (RR, 0.91; 95% CI, 0.67–1.22; P=0.522; I² = 0.0%; p_Q = 0.977), infections (RR, 1.09; 95% CI, 0.99–1.20; P=0.084; I² = 0.0%; p= 0.430), and deaths (RR, 0.67; 95% CI, 0.36–1.24; P=0.200; I² = 0.0%; p_Q = 0.439). Finally, the meta-regression analysis revealed that the complete response rate was not influenced by follow-up duration and sample size, but the rate was affected by publications between 2012 and 2014 compared to those between 2015 and 2020.

In conclusion, biological agents appeared to be effective and safe in managing patients with LN.

Reference: journals.lww.com/jclinrheum/Fulltext/2023/03000/Efficacy_and_Safety_of_Biologic_Agents_for_Lupus.6.aspx