Mendoza-Pinto, C, Pirone, C, van der Windt, DA, Parker, B and Bruce, IN (2017) Can we identify who gets benefit or harm from mycophenolate mofetil in systemic lupus erythematosus? a systematic review. Seminars in Arthritis and Rheumatism, 47 (1). pp. 65-78. ISSN 0049-0172

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AbstractObjectives We aimed to summarize the evidence examining factors that predict differential response to mycophenolate mofetil (MMF) in systemic lupus erythematosus (SLE). Methods Systematic searches of randomized clinical trials (RCT) to identify predictors of the effects of MMF (moderators), and cohort studies to explore prognostic factors associated with MMF outcomes (response, relapse or adverse events) were performed. Two reviewers independently assessed the methodological quality of RCTs using the Cochrane Collaboration risk of bias tool and cohort studies using the QUality In Prognosis Studies tool. The quality of subgroup analysis, providing evidence for moderation, was evaluated. The Grading of Recommendations Assessment, Development, and Evaluation working group approach summarized the quality of evidence (QoE), considering the risk of bias, imprecision, inconsistency, indirectness, and publication bias. Results From 26 studies (7 RCTs and 13 cohort studies) we found low QoE evidence for Black/Hispanic race/ethnicity predicting better renal responses to MMF in lupus nephritis (LN) from one RCT. There was low QoE evidence from cohort studies that a higher baseline creatinine and membranous features on renal biopsy were associated with poorer responses in LN. There was very low QoE for other moderators or prognostic factors associated with MMF treatment outcomes. QoE from RCTs was affected by exploratory or insufficient evidence from subgroup analysis and in both study types high risk of bias, indirectness and imprecision also affected QoE. Conclusions In SLE, evidence for predictors of response to MMF is limited and none can be recommended for use in routine clinical practice. Specific studies of predictors measured at baseline and during treatment are needed with ‘a priori’ hypotheses based on preliminary evidence to date and with sufficient power to determine which factors can be employed in clinical decision making.

Item Type: Article
Additional Information: This is the accepted author manuscript (AAM). The final published version (version of record) is available online via Elsevier at Please refer to any applicable terms of use of the publisher.
Uncontrolled Keywords: Systemic lupus erythematosus; Mycophenolate mofetil; Systematic review; Prognosis
Subjects: R Medicine > RA Public aspects of medicine
Divisions: Faculty of Medicine and Health Sciences > Primary Care Health Sciences
Depositing User: Symplectic
Date Deposited: 28 Mar 2017 09:56
Last Modified: 07 Jun 2018 12:11

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