A randomized, placebo-controlled trial of prednisone in early Henoch Schönlein Purpura [ISRCTN85109383]

Huber, Adam M.; King, Jim; McLaine, Peter N.; Klassen, Terry P.; Pothos, Mary

doi:10.1186/1741-7015-2-7

Cited by 168 publications

(92 citation statements)

References 22 publications

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“…Sano et al Other randomized and placebocontrolled trials have also found that the use of prednisone at the start of HSP does not avert kidney damage. 14,15 In our patients sample it was demonstrated that use of corticosteroids was associated with greater renal involvement, since these patients exhibited a greater frequency of severe gastrointestinal involvement and required these medications. These were habitually introduced during the first month of the disease and were predominantly indicated to control significant gastrointestinal manifestations, such as intermittent and severe abdominal pain in colic, and bleeding and intussusception.…”

Section: Discussionmentioning

confidence: 67%

Envolvimento renal na púrpura de Henoch-Schönlein: uma análise multivariada de fatores prognósticos iniciais

Almeida¹,

Campos²,

Paim³

et al. 2007

J. Pediatr. (Rio J.)

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Objectives: To identify initial predictive factors of renal involvement in children and adolescents with Henoch-Schönlein purpura. Methods:We reviewed the medical records of 142 patients admitted to our University Hospital over a 21-year period with a diagnosis of Henoch-Schönlein purpura. The initial predictive factors assessed, observed during the first 3 months, included: demographic data, clinical manifestations (persistent palpable purpura, arthritis, abdominal pain, severe abdominal pain, gastrointestinal bleeding, orchitis, central nervous system involvement and pulmonary hemorrhage), laboratory tests (serum IgA levels) and treatment given (corticosteroids, intravenous immunoglobulin and immunosuppressive drugs). Patients were divided into two groups (presence or absence of nephritis) and assessed by univariate and multivariate analysis.Results: Evidence of nephritis was detected in 70 patients (49.3%). The univariate analysis revealed that severe abdominal pain (p = 0.0049; OR = 1.6; 95%CI 1.18-2.21), gastrointestinal bleeding (p = 0.004; OR = 1.6; 95%CI 1.10-2.26) and corticosteroid use (p = 0.0012; OR = 1.7; 95%CI 1.28-2.40) were all associated with increased incidence of renal involvement. In the multivariate analysis, logistic regression demonstrated that the only independent variable that predicted nephritis was intense abdominal pain (p < 0.012; OR = 2.593; 95%CI 1.234-5.452). Conclusions:Severe abdominal pain was a significant predictor of nephritis in Henoch-Schönlein purpura.Consequently, pediatric patients exhibiting this clinical manifestation should be rigorously monitored, due to the increased risk of renal involvement.J Pediatr (Rio J). 2007;83(3):259-266: Henoch-Schönlein purpura, nephritis, children, kidney disease, prognosis.

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Section: Discussionmentioning

confidence: 67%

Envolvimento renal na púrpura de Henoch-Schönlein: uma análise multivariada de fatores prognósticos iniciais

Almeida¹,

Campos²,

Paim³

et al. 2007

J. Pediatr. (Rio J.)

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“…A systematic review, including three prospective, randomized, placebo-control trials and 12 retrospective trials, analyzed the efficacy of CS for HSP and found that early CS treatment at the onset of HSP significantly reduced the odds of developing persistent kidney disease (Weiss et al, 2007). However, these studies did not take account of the effects of CS on proteinuria or remission of HSPN and no ACEI or ARB was used as a control (Mollica et al, 1992;Saulsbury, 1993;Huber et al, 2004;Ronkainen et al, 2006). Based on the RCT data for IgAN, the KDIGO Glomerulonephritis Work Group (2012) suggested a six-month course of CS for HSPN patients with persistent proteinuria greater than 1 g/24 h, after a trial of ACEI or ARB.…”

Section: Discussionmentioning

confidence: 99%

Mycophenolate mofetil plus prednisone for inducing remission of Henoch-Schönlein purpura nephritis: a retrospective study

Han

Chen

Ren

et al. 2015

J. Zhejiang Univ. Sci. B

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Abstract:Objective: The treatment of Henoch-Schönlein purpura (HSP) with moderate proteinuria remains controversial. We retrospectively analyzed the efficacy of immune suppressants, with a particular emphasis on mycophenolate mofetil (MMF). Methods: Ninety-five HSP patients with moderate proteinuria (1.0-3.5 g/24 h) after at least three months of therapy with angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) were divided into three groups: an MMF group (n=33) that received MMF 1.0-1.5 g/d combined with prednisone (0.4-0.5 mg/(kgd)), a corticosteroid (CS) group (n=31) that received full-dose prednisone (0.8-1.0 mg/(kgd)), and a control group (n=31). Patients in the MMF and CS groups continued to take ACEI or ARB at the original dose. The patients in the control group continued to take ACEI or ARB but the dose was increased by (1.73±0.58)-fold. The patients were followed up for 6-78 months (median 28 months). Results: The baseline proteinuria was higher in the MMF group ((2.1±0.9) g/24 h) than in the control group ((1.6±0.8) g/24 h) (P=0.039). The proteinuria decreased significantly in all groups during follow-up, but only in the MMF group did it decrease significantly after the first month. At the end of follow-up, the proteinuria was (0.4±0.7) g/24 h in the MMF group and (0.4±0.4) g/24 h in the CS group, significantly lower than that in the control group ((0.9±1.1) g/24 h). The remission rates in the MMF group, CS group, and control group were respectively 72.7%, 71.0%, and 48.4% at six months and 72.7%, 64.5%, and 45.2% at the end of follow-up. The overall number of reported adverse events was 17 in the MMF group, 30 in the CS group, and 6 in the control group (P<0.001). Conclusions: MMF with low-dose prednisone may be as effective as full-dose prednisone and tend to have fewer adverse events. Therefore, it is probably superior to conservative treatments of adult HSP patients with moderate proteinuria.

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“…Some authors suggested treating only patients with risk factors for renal involvement at disease onset [18,22]. Prednisone is often favored over methylprednisolone during pregnancy, as transplacental passage occurs in small amounts, reducing the risk of fetal adverse effects [2,23]. Among the 20 cases of HSP during pregnancy, half were treated with steroids, leading to rapid resolution of purpura, abdominal symptoms or arthralgia [6].…”

Section: Discussionmentioning

confidence: 99%

Henoch Schönlein Purpura in Pregnancy: a Case with Uncomplicated Maternal and Neonatal Outcome

Tejada¹,

McCarey²,

Boehlen³

et al. 2015

Int. J. Gynecol. Obstet. & Neona. Care

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Abstract:Introduction: Henoch-Schönlein Purpura (HSP) is a systemic IgA-mediated small-vessel vasculitis. It is primarily a childhood disease, rarely described in pregnancy. Pregnant women with HSP are at risk for hypertensive and hemorrhagic complications. Due to the rarity of the condition during pregnancy, there is no consensus about the preferred course of treatment but concerns regarding optimal management are ongoing.Case presentation: We report the case of an 18 year-old primigravida, with a 3-year history of HSP, who had an uneventful pregnancy and term delivery with epidural anesthesia. Conclusion:Due to the systemic nature of HSP, multidisciplinary management of pregnant HSP patients should be warranted to prevent complications.

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A randomized, placebo-controlled trial of prednisone in early Henoch Schönlein Purpura [ISRCTN85109383]

Cited by 168 publications

References 22 publications

Envolvimento renal na púrpura de Henoch-Schönlein: uma análise multivariada de fatores prognósticos iniciais

Envolvimento renal na púrpura de Henoch-Schönlein: uma análise multivariada de fatores prognósticos iniciais

Mycophenolate mofetil plus prednisone for inducing remission of Henoch-Schönlein purpura nephritis: a retrospective study

Henoch Schönlein Purpura in Pregnancy: a Case with Uncomplicated Maternal and Neonatal Outcome

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