Tacrolimus and mycophenolate showed no significant difference in renal response in lupus nephritis, with different safety profiles

The edition in brief

An Asian multicentre randomised trial of 130 biopsy-proven class III or IV lupus nephritis patients compared tacrolimus plus glucocorticoid with mycophenolate plus glucocorticoid for 96 weeks. Sustained renal response at week 96 was 58.5% vs 69.2% and complete renal remission 55.4% vs 63.1%, neither significantly different. Adverse events were 80% in both; acute kidney injury and tremor were more frequent with tacrolimus, leucopenia and treatment-related serious adverse events (including serious infection) with mycophenolate, and all three deaths were in the mycophenolate group. A meta-analysis of 19 trials (1,636 peritoneal dialysis patients) found hemoglobin 7.3 g/L higher with roxadustat than erythropoiesis-stimulating agents, but with low certainty and heterogeneous comparators, so the authors judge the evidence insufficient to show superiority. A post hoc analysis of a 116-patient open-label trial found individualised potassium-guided sodium zirconium cyclosilicate on non-dialysis days gave sustained potassium control in 43.1% against 13.8% (adjusted RR 3.02), with biochemical outcomes only. In 1,130,961 US primary care patients, family history of kidney disease was recorded in 5.4%, far less than diabetes (39.1%), and was associated with chronic kidney disease (OR 1.39) and kidney failure (OR 3.15).