Evidence
This page contains a snapshot of featured content which highlights evidence addressing key clinical questions including areas of uncertainty. Please see the main topic reference list for details of all sources underpinning this topic.
BMJ Best Practice evidence tables
Evidence tables provide easily navigated layers of evidence in the context of specific clinical questions, using GRADE and a BMJ Best Practice Effectiveness rating. Follow the links at the bottom of the table, which go to the related evidence score in the main topic text, providing additional context for the clinical question. Find out more about our evidence tables.
This table is a summary of the analysis reported in a Cochrane Clinical Answer that focuses on the above important clinical question.
Confidence in the evidence is very low or low where GRADE has been performed and there may be no difference in effectiveness between the intervention and comparison for key outcomes. However, this is uncertain and new evidence could change this in the future.
Population: Adolescents and adults with lupus nephritis
Intervention: Oral mycophenolate ᵃ
Comparison: Intravenous cyclophosphamide ᵃ
| Outcome | Effectiveness (BMJ rating)? | Confidence in evidence (GRADE)? |
|---|---|---|
All‐cause mortality (mean follow‐up 24 weeks) | No statistically significant difference | Very Low |
End-stage kidney disease (mean follow‐up 32 weeks) | No statistically significant difference | Very Low |
Renal relapse | No statistically significant difference | GRADE assessment not performed for this outcome |
Stable kidney function | No statistically significant difference | GRADE assessment not performed for this outcome |
Renal remission: complete or partial (mean follow‐up 24 weeks) | No statistically significant difference | Low |
Renal remission: complete or partial remission in proteinuria (mean follow‐up 24 weeks) | No statistically significant difference | GRADE assessment not performed for this outcome |
Daily proteinuria | No statistically significant difference | GRADE assessment not performed for this outcome |
Adverse effects/toxicity: ovarian failure (mean follow‐up 24 weeks) | No statistically significant difference | Very Low |
Adverse effects/toxicity: alopecia (mean follow‐up 24 weeks) | Occurs more commonly with cyclophosphamide compared with mycophenolate (favours intervention) | Moderate |
Adverse effects/toxicity: leukopaenia (mean follow‐up 24 weeks) | No statistically significant difference | GRADE assessment not performed for this outcome |
Adverse effects/toxicity: diarrhoea (mean follow‐up 24 weeks) | Occurs more commonly with mycophenolate compared with cyclophosphamide (favours comparison) | Moderate |
Doubling of serum creatinine, Adverse effects/toxicity (bone toxicity) | - | None of the studies identified by the review assessed these outcomes |
Note The Cochrane Clinical Answer (CCA) also compared oral mycophenolate with oral cyclophosphamide as first-line induction for proliferative lupus nephritis. They found one small RCT (62 people) that had similar results with no statistically significant difference between groups for all-cause mortality or renal outcomes. ᵃ This evidence table summarises the findings for the comparison of oral mycophenolate versus intravenous cyclophosphamide, which is the main comparison as stated in the Cochrane review Summary of Findings table. See the full CCA for more information.
This evidence table is related to the following section/s:
Cochrane Clinical Answers
Cochrane Clinical Answers (CCAs) provide a readable, digestible, clinically focused entry point to rigorous research from Cochrane systematic reviews. They are designed to be actionable and to inform decision making at the point of care and have been added to relevant sections of the main Best Practice text.
- How do mycophenolate mofetil and cyclophosphamide compare with each other and with alternative induction therapies for people with lupus nephritis?
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