Comparing the Efficacy and Safety of Induction Therapies for the Treatment of Patients with Proliferative Lupus Nephritis in South Africa

Abstract

Background. Lupus nephritis (LN) can be complicated with requirement for kidney replacement therapy and death. Efficacy of induction therapies using mycophenolate mofetil (MMF) or intravenous cyclophosphamide (IVCYC) has been reported from studies, but there is limited data in Africans comparing both treatments in patients with proliferative LN. Methods. This was a retrospective study of patients with biopsy-proven proliferative LN diagnosed and treated with either MMF or IVCYC in a single centre in Cape Town, South Africa, over a 5-year period. The primary outcome was attaining complete remission after completion of induction therapy. Results. Of the 84 patients included, mean age was 29.6 ± 10.4 years and there was a female preponderance (88.1%). At baseline, there were significant differences in estimated glomerular filtration rate (eGFR) and presence of glomerular crescents between both groups ( p ≤ 0.05 ). After completion of induction therapy, there was no significant difference in remission status (76.0% versus 87.5%; p = 0.33 ) or relapse status (8.1% versus 10.3%; p = 0.22 ) for the IVCYC and MMF groups, respectively. Mortality rate for the IVCYC group was 5.5 per 10,000 person-days of follow-up compared to 1.5 per 10,000 person-days of follow-up for the MMF group ( p = 0.11 ), and there was no significant difference in infection-related adverse events between both groups. Estimated GFR at baseline was the only predictor of death (OR: 1.0 [0.9–1.0]; p = 0.001 ). Conclusion. This study shows similar outcomes following induction treatment with MMF or IVCYC in patients with biopsy-proven proliferative LN in South Africa. However, a prospective and randomized study is needed to adequately assess these outcomes.

Comparison between oral Mycophenolate Mofetil and intravenous Cyclophosphamide for the treatment of the lupus nephritis patients

“…Similarly, the current results found no significant difference in the recorded rate between both treatment groups, which is consistent with what has been reported by Sogayise et al 21 Our findings are congruent with those of Sahay et al 22 , who examined the efficacy of three LN therapy regimens (ELNT, NIH, and MMF). The European Lupus Nephritis Trial (ELNT) regimen included six 500 mg IV CYC doses given biweekly, but the National Institute of Health (NIH) regimen included 0.5 g/m 2 monthly treatment for six months, with MMF given at a dosage of 1200 mg/m 2 .…”

Infection profile and risk factors for mortality in patients with end-stage renal disease attributable to systemic lupus erythematosus: a two-center integrated study

“… 23 Many cases of SLE are complicated by various infections attributable to the primary disease or compromised immune function caused by drug treatment. 24 , 25 Differentiating infections from high disease activity is crucial in patients with autoimmune diseases such as SLE. 26 , 27 …”

“…23 Many cases of SLE are complicated by various infections attributable to the primary disease or compromised immune function caused by drug treatment. 24,25 Differentiating infections from high disease activity is crucial in patients with autoimmune diseases such as SLE. 26,27 Our study demonstrated that pulmonary infection was most common, followed by urinary and intestinal infection, which was consistent with the results of other research.…”