SYSTEMATIC REVIEW article
Front. Immunol.
Sec. Autoimmune and Autoinflammatory Disorders : Autoimmune Disorders
This article is part of the Research TopicTherapeutic Agents for Lupus TreatmentView all articles
Efficacy and safety of calcineurin inhibitor therapy in lupus nephritis: a systematic review and network meta-analysis
Provisionally accepted
- 1Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital Department of Pharmacy, Nanjing, China
- 2China Pharmaceutical University, Nanjing, China
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Introduction The aim of this study is to compare the efficacy and safety of calcineurin inhibitors in the treatment of lupus nephritis. Methods We systematically searched several electronic databases (PubMed, Embase, Cochrane Library, and Web of Science) and the clinical trial registry ClinicalTrials.gov from their inception to March 1, 2025. Our study included randomized controlled trials that enrolled adult lupus nephritis patients receiving calcineurin inhibitors. The outcomes included renal remission rate and incidence of adverse reactions. The network meta-analysis was performed using Stata 14.0. Results Sixteen randomized controlled trials (with a total of 2069 patients) met the inclusion criteria. Regarding total remission, voclosporin-based triple therapy (mycophenolate mofetil + steroid) ranked highest (surface under the cumulative ranking curve [SUCRA] = 92.7%), followed by tacrolimus-based triple therapy (SUCRA = 87.5%). For safety outcomes, no statistically significant intergroup differences were observed in adverse events, serious adverse events, or adverse events leading to treatment discontinuation. However, further analysis revealed that voclosporin-based therapy was associated with the highest infection rate (SUCRA = 20.6%), indicating a potential safety concern compared to other regimens; tacrolimus-based therapy had the second-highest infection risk (SUCRA = 27.0%). Conclusions Voclosporin-and tacrolimus-based triple therapies (both combined with mycophenolate mofetil and steroid) demonstrated high efficacy in lupus nephritis patients. Based on indirect comparisons, the voclosporin regimen appeared to be the most effective. However, it also posed a significantly higher infection risk than other treatments. This underscores that while pursuing high remission rates, vigilant infection monitoring and proactive management are imperative.
Keywords: Calcineurin inhibitor, efficacy, Lupus Nephritis, Networkmeta-analysis, Safety
Received: 21 Jul 2025; Accepted: 08 Dec 2025.
Copyright: © 2025 Wu, Cai, Yao and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Jinping Zhang
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.