SYSTEMATIC REVIEW article
Front. Immunol.
Sec. Autoimmune and Autoinflammatory Disorders : Autoimmune Disorders
Efficacy and safety of six immunoadsorption treatments for severe lupus nephritis: a Bayesian network meta-analysis and systematic review
Provisionally accepted
- 1辽宁中医药大学, 沈阳1, China
- 2School of Basic Medical Sciences, Liaoning University of Traditional Chinese Medicine, Shenyang, Liaoning Province, China, Shenyang, Liaoning, China
- 3Shengjing Hospital affiliated to China Medical University,Shenyang City, Liaoning Province, China, Shenyang City, Liaoning Province,, China
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Background: Severe lupus nephritis (LN) remains difficult to manage despite standard immunosuppressive therapy. Immunoadsorption (IA) has been increasingly used as an adjunctive treatment; however, comparative evidence across different IA columns is limited. Methods: We conducted a systematic review and Bayesian network meta-analysis of randomized controlled trials evaluating six IA columns for severe LN. PubMed, Embase, Scopus, Web of Science, VIP, Wanfang, and CNKI were searched up to January 2025. Outcomes included disease activity (SLEDAI), renal parameters, immunological markers, and adverse events. Risk of bias was assessed using the Cochrane risk-of-bias tool, and Bayesian network meta-analysis was performed in R (version 4.4.1). Results: Twenty-four randomized controlled trials involving 1,442 patients were included. DNA280 plus conventional pharmacotherapy showed a favorable probability ranking for SLEDAI improvement. DNA280 plus plasma exchange (PE) plus conventional pharmacotherapy showed a statistically significant advantage versus conventional pharmacotherapy alone (MD=1.8, 95% CrI 0.05–3.5) for 24-hour proteinuria and ranked favorably across several renal outcomes. PH-350 plus conventional pharmacotherapy showed a favorable probability ranking for serum creatinine improvement. Adverse events were reported in 17 studies, but comparative safety analyses were not feasible due to inconsistent definitions and reporting. Conclusions: IA strategies—particularly DNA280-based regimens—may offer relative advantages for severe LN, but the evidence is limited by study quality, heterogeneity, sparse comparisons for some columns, and reliance on surrogate outcomes. Findings should be interpreted as hypothesis-generating, and higher-quality comparative trials with clinically meaningful endpoints are needed.
Keywords: Bayesian model, DNA280 Adsorption Column, HA280Adsorption Column, PH-350 Adsorption column, Staphylococcal Protein A
Received: 07 Jul 2025; Accepted: 19 Jan 2026.
Copyright: © 2026 Zheng, Liu, Zhang, Jia, Xia, Xu, Wu and Ji. 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:
Yin Zheng
tong Si Wu
Hong Ji
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