Use of Tacrolimus and Voclosporin as Induction Therapy in Lupus Nephritis: A Focused Systematic Review and Meta-Analysis of Randomized Evidence
Abstract
Background: : Lupus nephritis (LN) remains a major cause of morbidity among patients with systemic lupus erythematosus, and treatment resistance continues to pose clinical challenges. Calcineurin inhibitors (CNIs), including tacrolimus (TAC) and voclosporin (VCS), have emerged as adjuncts to standard induction therapy. This systematic review and meta-analysis identified and quantified the randomized evidence for TAC and for VCS as induction therapy in LN, summarizing the pooled effect of each agent against its trial comparators, with an exploratory adjusted indirect comparison provided for hypothesis generation.
Methods:: Following PRISMA guidelines, a comprehensive literature search was conducted through June 2025. Eligible studies were randomized controlled trials enrolling adults with biopsy-proven active class III, IV, or V LN and reporting complete or partial renal response after TAC- or VCS-based therapy. Pooled risk ratios (RRs) were calculated using a random-effects model, and an indirect Bucher comparison was performed.
Results:: Five multinational randomized controlled trials, including 1,433 participants, were analyzed. TAC significantly improved renal response compared with conventional induction therapy (RR, 1.36; 95% CI, 1.00–1.86; p = 0.048), with substantial heterogeneity (I² = 73%). VCS also significantly improved renal response (RR, 1.78; 95% CI, 1.35–2.34; p < 0.0001), with low heterogeneity (I² = 0%). Indirect comparison showed no statistically…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 1,433 participants or records.
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