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

## TL;DR

This study compares six immunoadsorption treatments for severe lupus nephritis, finding some may improve outcomes compared to standard therapy.

## Contribution

The study provides a Bayesian network meta-analysis comparing six immunoadsorption columns for severe lupus nephritis, a novel comparative analysis in this context.

## Key findings

- DNA280 plus conventional therapy showed favorable probability for improving SLEDAI scores.
- DNA280 plus plasma exchange plus conventional therapy significantly reduced 24-hour proteinuria.
- PH-350 plus conventional therapy ranked favorably for serum creatinine improvement.

## Abstract

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.

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).

A total of 24 randomized controlled trials involving 1,442 patients were included. DNA280 plus conventional pharmacotherapy showed a favorable probability ranking for SLEDAI improvement. DNA280 plus plasma exchange (PE) plus conventional pharmacotherapy showed a statistically significant advantage versus 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.

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.

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD420251031348.