Work

Efficacy and safety of six immunoadsorption treatments for severe lupus nephritis: a Bayesian network meta-analysis and systematic review

Year: 2026

Type: review

Study designs: Systematic Review, Meta-Analysis

Abstract: 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 (Systemic Lupus Erythematosus Disease Activity Index, 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: conventional pharmacotherapy alone [mean difference (MD) = 1.8, 95% credible interval (95%CrI) = 0.05-3.5] for 24-h 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; however, comparative safety analyses were not feasible due to inconsistent definitions and reporting. Conclusions: IA strategies-in particular DNA280-based regimens-may offer relative advantages for severe LN. However, the evidence is limited by study quality, heterogeneity, sparse comparisons for some columns, and reliance on surrogate outcomes. The findings should be interpreted as hypothesis-generating, and higher-quality comparative trials with clinically meaningful endpoints are needed. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD420251031348.

Source: Frontiers in Immunology

DOI: 10.3389/fimmu.2026.1661291

Authors: Jiazhen Liu, Yin Zheng, Xuxin Zhang, Jiani Xia, Kewei Jia, Yi Zhao

Institutions: Liaoning University of Traditional Chinese Medicine, First Hospital of China Medical University

Language: English

Topic: Systemic Lupus Erythematosus Research

Subfield: Rheumatology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,801