Efficacy and safety of Belimumab, Rituximab and Voclosporin in the treatment of lupus nephritis based on registered clinical trials: A systematic review and network meta-analysis

Objective To systematically compare the clinical effectiveness and safety of Belimumab, Rituximab and Voclosporin in the treatment of lupus nephritis based on network meta-analysis method. Methods Systematic search of registered clinical trials in four major databases (Pubmed, Embase, Web of Science, The Cochrane Register of Clinical Trials) and ClinicalTrials.gov. According to the inclusion and exclusion criteria of the protocol, Screening of registered randomized controlled clinical trials of Belimumab, Rituximab and Voclosporin in the treatment of lupus nephritis. Results This study included a total of five registered randomized controlled clinical trials involving 1212 subjects. In terms of complete renal remission, Voclosporin −1 year, High-Voclosporin-1 year, Voclosporin-2 years and Belimumab-2 years were all significantly better than placebo; At the same time, the effect of Voclosporin-1 year on complete renal remission rate was significantly better than that of Rituximab-1 year [OR = 3.2, 95% CI (1.41,7.24)]. In terms of safety, placebo was significantly better than High-Voclosporin-1 year [OR = 0.23, 95% CI (0.07,0.82)], and the difference was statistically significant; There was no significant difference in the incidence of serious adverse events. Conclusion Voclosporin and Belimumab showed significant clinical efficacy in the treatment of lupus nephritis, and the safety was not statistically different from placebo. Voclosporin had significantly better clinical efficacy than Rituximab during 1-year treatment period. Increasing the dose of Voclosporin did not significantly improve the efficacy, but it will increase the safety risk of adverse events.