***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Treatment of lupus nephritis ( LN ) with cyclophosphamide ( CYC ) is effective but retains a certain severe adverse effect . Tacrolimus ( TAC ) may be a suitable treatment for LN . Forty patients with diffuse proliferative or membranous LN were recruited for this non-r and omized open-label study — 67.5 % ( 27/40 ) had nephrotic proteinuria ( > 3.5 g/day ) and 50.0 % ( 20/40 ) had low estimated glomerular filtration rate ( eGFR ) ( < 60 mL/min/1.73m2 ) . We compared the efficacy and adverse effects of TAC ( 0.04–0.08 mg/kg/d)/prednisone for 12 months ( TAC group , n = 20 ) with intravenous CYC ( 750 mg/m2 per month)/prednisone for six months followed by azathioprine ( Aza ) ( 100 mg/day)/prednisone for six months ( CYC group , n = 20 ) . The TAC target concentration was 6–8 ng/mL or 4–6 ng/mL , respectively , when induction or maintenance therapy was required and 4.0 ng/mL for patient with renal insufficiency . In the TAC group , mean urinary protein excretion decreased significantly from 5.00 ± 1.91 g/day at baseline to 2.54 ± 1.68 g/day after two weeks of therapy ( P < 0.001 ) , compared with the CYC group ( 4.9 ± 19.4 g/day ) , P = 0.001 , and 65.0 % ( 13/20 ) achieved partial remission at one month , compared with the CYC group ( 0/20 ) , P < 0.001 . The incidence of complete remission ( CR ) was significantly higher in the TAC group than in the CYC group ( 55.0 % vs.15.0 % by five months , P = 0.008 , and 75.0 % vs.40.0 % by 12 months , P = 0.025 , respectively ) . The significant improvement in serum anti-dsDNA and systemic lupus erythematosus ( SLE ) disease activity index ( DAI ) was in the TAC group relative to the CYC group at 12 months ( P = 0.031 , P = 0.003 , respectively ) . The eGFR improved in the TAC group from 59.90 ± 23.64 mL/min/1.73m2 at baseline to 93.75 ± 28.52 mL/min/1.73m2 after 12 months , P = 0.001 . In the CYC group , two patients developed end-stage renal disease ( ESRD ) , three patients experienced serious pneumonia , and one patient died . Our preliminary study showed TAC is a safe and effective treatment for LN with severe renal disease  , and with less-severe adverse events compared with CYC followed Aza therapy . Further larger sample studies are needed to confirm our conclusion OBJECTIVE To investigate the efficacy and safety of ocrelizumab in patients with class III/IV lupus nephritis ( LN ) . METHODS Patients were r and omized 1:1:1 to receive placebo , 400 mg ocrelizumab , or 1,000 mg ocrelizumab given as an intravenous infusion on days 1 and 15 , followed by a single infusion at week 16 and every 16 weeks thereafter , accompanied by background glucocorticoids plus either mycophenolate mofetil ( MMF ) or the Euro-Lupus Nephritis Trial ( ELNT ) regimen ( cyclophosphamide followed by azathioprine ) . The study was terminated early due to an imbalance in serious infections in  ocrelizumab-treated patients versus  placebo-treated patients . We report week 48 efficacy data for patients receiving ≥32 weeks of treatment ( n = 223 ) and safety results for all treated patients ( n = 378 ) . RESULTS The overall renal response rate was 54.7 % , 66.7 % , 67.1 % , and 66.9 % in the placebo-treated , 400 mg ocrelizumab-treated , 1,000 mg ocrelizumab-treated , and combined ocrelizumab-treated groups , respectively . The associated treatment difference versus placebo for the combined ocrelizumab-treated groups was 12.7 % ( 95 % confidence interval [ 95 % CI ] -0.8 , 26.1 ) ( P = 0.065 ) , with similar differences observed for both ocrelizumab-treated groups . Ocrelizumab versus placebo treatment differences were apparent in patients receiving the background ELNT regimen , but not in those receiving background MMF . A numerically greater proportion of ocrelizumab-treated patients had a ≥50 % reduction in the urinary protein : urinary creatinine ratio at 48 weeks compared with placebo-treated patients ( placebo-treated patients , 58.7 % ; 400 mg ocrelizumab-treated patients , 70.7 % ; 1,000 mg ocrelizumab-treated patients , 68.5 % ) . Serious adverse events occurred in 27.2 % of placebo-treated patients , 35.7 % of 400 mg ocrelizumab-treated patients , and 22.0 % of 1,000 mg ocrelizumab-treated patients . Corresponding serious infection rates ( events/100 patient-years ) were 18.7 ( 95 % CI 12.2 , 28.7 ) , 28.8 ( 95 % CI 20.6 , 40.3 ) , and 25.1 ( 95 % CI 17.4 , 36.1 ) , respectively . The imbalance in serious infections with ocrelizumab occurred with background MMF but not with the background ELNT regimen . CONCLUSION In patients with active LN , overall renal response rates with ocrelizumab were numerically but not statistically significantly superior to those with placebo . Ocrelizumab treatment was associated with a higher rate of serious infections in the subgroup receiving background MMF BACKGROUND Intravenous cyclophosphamide with prednisone is an effective treatment for lupus nephritis , but with significant toxicities . We compared the efficacy and safety of tacrolimus versus intravenous cyclophosphamide as induction therapy . STUDY DESIGN Multicenter noninferiority r and omized controlled trial . SETTING & PARTICIPANTS 81 patients with biopsy-proven lupus nephritis from 9 nephrology centers in China from 2006 - 2008 . INTERVENTION Prednisone and either tacrolimus ( n = 42 ) or intravenous cyclophosphamide ( n = 39 ) for 6 months . Tacrolimus was started at 0.05 mg/kg/d and titrated to achieve a trough blood concentration of 5 - 10 ng/mL. Intravenous cyclophosphamide was initiated at 750 mg/m² of body surface area , then adjusted to 500 - 1,000 mg/m² every 4 weeks for a total of 6 pulse treatments . OUTCOMES & MEASUREMENTS The primary outcome was complete remission ( proteinuria with protein excretion < 0.3 g/24 h , serum albumin ≥3.5 g/dL , normal urinary sediment , and normal or stable serum creatinine level ) at 6 months . Response ( complete or partial remission ) , clinical parameters , and adverse effects were secondary end points . RESULTS After the 6-month induction therapy , the tacrolimus group achieved higher cumulative probabilities of complete remission and response ( 52.4 % vs 38.5 % and 90.5 % vs 82.1 % , respectively ) than the intravenous cyclophosphamide group , but differences were not statistically significant ( log-rank test , P = 0.2 and P = 0.7 , respectively ) . Proteinuria [ corrected ] was significantly decreased in tacrolimus- versus intravenous cyclophosphamide-treated patients after the first month of treatment , even with adjustment for baseline proteinuria ( protein excretion , 1.76 vs 2.40 g/d ; P = 0.02 for the log-transformed analysis ) . [ corrected ] After treatment , serum creatinine levels and estimated glomerular filtration rates were not significantly different between treatment groups . Adverse effects , such as leukopenia and gastrointestinal symptoms , were less frequent in the tacrolimus group . LIMITATIONS Nonblinded , small sample size , and short duration of follow-up . CONCLUSIONS In conjunction with prednisone , induction therapy with tacrolimus is at least as efficacious as intravenous cyclophosphamide and prednisone in producing complete remission of lupus nephritis and has a more favorable safety profile Treatment of class V+IV lupus nephritis remains unsatisfactory despite the progress made in the treatment of diffuse proliferative lupus nephritis . In this prospect i ve study , 40 patients with class V+IV lupus nephritis were r and omly assigned to induction therapy with  mycophenolate mofetil , tacrolimus , and steroids ( multitarget therapy ) or intravenous cyclophosphamide ( IVCY ) . Patients were treated for 6 mo unless complete remission was not achieved , in which case treatment was extended to 9 mo . An intention-to-treat analysis revealed a higher rate of complete remission with multitarget therapy at both 6 and 9 mo ( 50 and 65 % , respectively ) than with IVCY ( 5 and 15 % , respectively ) . At 6 mo , eight ( 40 % ) patients in each group experienced partial remission , and at 9 mo , six ( 30 % ) patients receiving multitarget therapy and eight ( 40 % ) patients receiving IVCY experienced partial remission . There were no deaths during this study . Most adverse events were less frequent in the multitarget therapy group . Calcineurin inhibitor nephrotoxicity was not observed , but three patients developed new-onset hypertension with multitarget therapy . In conclusion , multitarget therapy is superior to IVCY for inducing complete remission of class V+IV lupus nephritis and is well tolerated BACKGROUND Although the use of aggressive immunosuppression has improved both patient and renal survival of patients with lupus nephritis ( LN ) , the optimal treatment of LN remains challenging . The objective of this study is to assess the efficacy and safety of mycophenolate mofetil ( MMF ) and tacrolimus compared with intravenous cyclophosphamide ( IVC ) as induction therapies for active lupus nephritis ( ALN ) . METHODS In this open-label , 24-week prospect i ve study , 60 patients with biopsy-proven ALN ( Classes III , IV , V or combination ) were r and omly assigned to receive MMF , tacrolimus or IVC in combination with corticosteroids . The remission of proteinuria , systemic lupus erythematosus disease active index and adverse events were compared . RESULTS The response rates at 24 weeks were 70 % ( 14/20 ) in the MMF group , 75 % ( 15/20 ) in the tacrolimus group and 60 % ( 12/20 ) in the IVC group ( P>0.05 ) . The complete remission rates were also similar in the three groups ( 40 , 45 and 30 % , respectively ; P>0.05 ) . There were more cases of infection in the IVC group ( 8/20 ) and the MMF group ( 8/20 ) than the tacrolimus group ( 3/20 ) and more hyperglycemia in the tacrolimus group ( 5/20 ) than the other two groups ( 2 or 3/20 ) , but the results were not statistically significant among the three groups . Proteinuria decreased and serum albumin increased more quickly in the patients treated with tacrolimus ( P=0.0051 and P=0.048 ) . CONCLUSIONS This pilot study suggests that both MMF and tacrolimus are possible alternatives to IVC as induction therapies for ALN in Chinese patients .  Tacrolimus possibly results in a faster resolution of proteinuria and hypoalbuminemia . Further studies are necessary to determine the optimal dosage and duration of the therapies Recent studies have suggested that mycophenolate mofetil ( MMF ) may offer advantages over intravenous cyclophosphamide ( IVC ) for the treatment of lupus nephritis , but these therapies have not been compared in an international r and omized , controlled trial . Here , we report the comparison of MMF and IVC as induction treatment for active lupus nephritis in a multinational , two-phase ( induction and maintenance ) study . We r and omly assigned 370 patients with classes III through V lupus nephritis to open-label MMF ( target dosage 3 g/d ) or IVC  ( 0.5 to 1.0 g/m(2 ) in monthly pulses ) in a 24-wk induction study . Both groups received prednisone , tapered from a maximum starting dosage of 60 mg/d . 
    Output:
    
Conclusions Infection remains a serious complication during treatment of lupus nephritis , but the reported rates and outcomes varied markedly .
Mycophenolate was associated with lower infection risk than cyclophosphamide in non-Asians .
Infection-related deaths appeared more common in Asian patients