Early response to immunosuppressive therapy predicts good renal outcome in lupus nephritis: Lessons from long‐term followup of patients in the Euro‐Lupus Nephritis Trial

Houssiau, Frédéric; Vasconcelos, Carlos; D’Cruz, David; Sebastiani, Gian Domenico; Garrido, Enrique de Ramón; Danieli, Maria Giovanna; Abramovicz, Daniel; Blockmans, Daniel Engelbert; Mathieu, Alessandro; Direşkeneli, Haner; Gargiulo, Mauro; Gül, Ahmet; Levy, Yair; Petera, P; Popović, R; Petrović, Radmila; Sinico, Renato Alberto; Cattaneo, Roberto; Font, Josep; Depresseux, Geneviève; Cosyns, Jean‐Pierre; Cervera, Ricard

doi:10.1002/art.20666

Cited by 342 publications

(214 citation statements)

References 15 publications

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“…The influence of renal reserve at baseline and after treatment on long-term renal outcome has been reported previously (11,12). These data thus highlight the complementary merits of assessing overall renal function and performing histologic examination of a fraction of renal parenchyma.…”

supporting

confidence: 59%

Histologic deterioration and more flares: The case against azathioprine plus methylprednisolone in the treatment of proliferative lupus nephritis

Chan¹

2007

Arthritis & Rheumatism

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An ideal immunosuppressive treatment for severe lupus nephritis should be devoid of adverse effects but potent enough to abate the inflammatory process rapidly. Corticosteroid combined with cyclophosphamide (CYC) has been the conventional treatment, although the side effects of CYC are well recognized. In this issue of Arthritis & Rheumatism, Grootscholten et al (1) report that an immunosuppressive regimen comprising methylprednisolone (MP) (9 intravenous 1-gm pulses in 2 months)/prednisone (20 mg/day tapered to 10 mg/day over 5 months) and azathioprine (AZA) (2 mg/kg/day) given for 2 years was associated with more progression of chronic renal histopathologic lesions compared with prednisone (1 mg/ kg/day for 4 weeks tapered to 10 mg/day after 6 months) and CYC (6 intravenous 750-mg/m 2 pulses given at 4-week intervals followed by 7 pulses given at 12-week intervals) (2). These conclusions were based on findings in 39 pairs of renal biopsy samples, obtained at baseline and after 2 years of treatment. In another report from the same study it was noted that, while high response rates (ϳ90%) were achieved with both treatment regimens, relapses were more frequent in the AZA plus MP group (2).In the pathologic study (1), 10.3% of patients showed doubling of the baseline serum creatinine level at the last followup (median followup 77 months), and the AZA plus MP regimen was associated with a 5.2-fold increase in risk of this outcome compared with the CYC regimen. Thus, there was concordance between renal function and histologic end points.

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supporting

confidence: 59%

Histologic deterioration and more flares: The case against azathioprine plus methylprednisolone in the treatment of proliferative lupus nephritis

Chan¹

2007

Arthritis & Rheumatism

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“…Many studies have come to the conclusion that the effect of the low-dose therapy is comparable with the recommended high-dose regimen and with a considerably low incidence of infections [3,[11][12][13]. However, our results showed that the incidence of infections between the two groups had no notable differences.…”

Section: Discussioncontrasting

confidence: 57%

Short-interval lower-dose intravenous cyclophosphamide as induction and maintenance therapy for lupus nephritis: a prospective observational study

Zhang

et al. 2014

Clin Rheumatol

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Cyclophosphamide (CYC) has long been considered a gold standard in inducing renal remission and preventing renal flares for patients with systemic lupus erythematosus (SLE). However, the rational use of CYC has not reached a consensus, such as the timing and length of treatment, the route of administration, and the ideal dosage. The objective of this study was to assess the efficacy and safety of short-interval lower-dose (SILD) intravenous (IV) CYC in the treatment of SLE. A total of 225 patients with lupus nephritis were randomly assigned to a 1-year trial, either the SILD group (12 fortnightly pulses at a fixed dose of 400 mg followed by 6 monthly pulses) or high-dose (HD) group (6 monthly pulses followed by two quarterly pulses at a dose of 0.5~1.0 g/m 2 ). At 6 months of treatment, 28 % (30/107) of patients in the SILD group reached a complete remission (CR), and 51.4 % (55/107) were in partial remission (PR), as compared with 32.7 % (35/107) and 45.8 % (49/107) in the HD group, respectively. Serum albumin, 24-h urinary protein, and the scores of disease activity were significantly improved in both groups at 6 months and maintained at the end of clinical trial. However, the SILD group showed much less menstrual disturbances (11.5 %), gastrointestinal adverse effects (5.3 %), and leukopenia (9.7 %) than the HD group (28.6, 26.8, and 19.8 %, respectively) at the end of clinical trial. The efficacy of the short-interval lower-dose (SILD) IV CYC regimen in the treatment of lupus nephritis is equivalent to that of the high-dose (HD) regimen, whereas the incidence of adverse events is much lower in the SILD group.

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“…These include increased disease recognition with more sensitive diagnostic tests, earlier diagnosis and treatment [18,19].…”

Section: Discussionmentioning

confidence: 99%

Predictive Factors and Long Term Outcome in Lupus Nephritis in Libya

Zaid¹,

Salem²

2018

Rheumatology

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Lupus Nephritis (LN) is a major cause of morbidity and mortality in patients with systemic lupus erythematosus. Prompt recognition and treatment of renal disease is important, as early response to therapy is correlated with better outcome. The main purpose of this study is evaluation lupus nephritis, outcome of lupus nephritis, and studies predictive factors in lupus nephritis are improved outcome. Patient and methods:Follow up study patients diagnosed as Systemic Lupus Erythematosus (SLE) according to the American College of Rheumatology (ACR), from the registration file of Rheumatology clinic, These patients were studied clinically for the presence of lupus nephritis, laboratory test CBP, ESR, RFT, Urine sedimentation, USS Abdomen, Doppler renal and use immunology test ANA positively was more than 1:160, anti-DNA Serum compliment levels (C3, C4), anti-ENA.Result: Clinical presentation of lupus nephritis was asymptomatic lupus nephritis is (6.6%), Nephritis lupus nephritis (24 h urine collection<3 g/d) is (36.8%), Nephrotic disease (24 h urine collection ≥ 3 g/d) is (28.9%) and acute renal failure is (27.6%), Albumin urine collection g/d range from 0.6-6 g/24 h, M=2.1 ± 1.1, blood urea ranged from 18-200 mg/dl, M=90.9 ± 47.6, serum creatinine was 0.5-6.7 mg/dl, M=2.6 ± 1.8, Hypertension patients of lupus nephritis was (89.5%). Positive ANA was (93.4%), positive Ds DNA was (94.7%), and low complement C3, C4 was (94.7%) and positive anti cardiolipin antibody AGL was (23.7%) recurrent attack lupus nephritis was (14.5%). The renal biopsy was done found diffuse proliferative lupus nephritis was (45.5%), Focal proliferative lupus nephritis was (20.8%) and mesangial proliferative lupus nephritis was (16.9%). management of lupus nephritis and choice of therapy according guideline European League against Rheumatism (EULAR), patients were received azathioprine (13.2%), IV injection Cyclophosphamide therapy was (21.1%), mycophenolate mofetil was (55.3%) and injection rituximab was (10.5%). Outcome lupus nephritis was complete response (64.5%), Partial response was (13.2%), resistance lupus nephritis was (22.1%), end stage renal failure on hemodialysis was (7.9%), conservative chronic renal failure was (14.5%) and mortality of lupus nephritis was (13.2%) Conclusion: Most common type diffuse proliferative lupus nephritis followed Focal proliferative lupus nephritis then mesangial proliferative lupus nephritis, induction therapy with mycophenolate mofetil or cyclophosphamide or rituximab in inducing complete remission of lupus nephritis is 64%. Even with standard therapy the end stage renal failure was (14.5%) and mortality of lupus nephritis was (13.2%) in this study. The impact of several factors like sex, age, race, duration of lupus nephritis, serum urea, serum creatinine and renal biopsy have statistical significance correlation and predictive effect on outcome lupus nephritis.

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Early response to immunosuppressive therapy predicts good renal outcome in lupus nephritis: Lessons from long‐term followup of patients in the Euro‐Lupus Nephritis Trial

Cited by 342 publications

References 15 publications

Histologic deterioration and more flares: The case against azathioprine plus methylprednisolone in the treatment of proliferative lupus nephritis

Histologic deterioration and more flares: The case against azathioprine plus methylprednisolone in the treatment of proliferative lupus nephritis

Short-interval lower-dose intravenous cyclophosphamide as induction and maintenance therapy for lupus nephritis: a prospective observational study

Predictive Factors and Long Term Outcome in Lupus Nephritis in Libya

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