Leflunomide plus oral prednisone in treatment of idiopathic membranous nephropathy: A retrospective clinical study of efficacy and safety

Yang, Shifeng; Xie, Liyi; Xue, Wujun; Yin, Aiping; Lu, Wei

doi:10.1111/nep.12143

Cited by 12 publications

(17 citation statements)

References 26 publications

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“…It is also associated with a lower amount of prednisone required to maintain remission and with a lower rate of relapse than with CTX therapy. 27,28 LEF is excreted in the urine via the kidney (43%) and in the feces via bile (48%). The chemical name of LEF is 5-methyl-N-[4-trifluero-methylphenyl]-5-methy-lisoxazole-4-carboxamide.…”

Section: Discussionmentioning

confidence: 99%

“…The results were consistent with those of previous studies. 27,28 The total efficacy rates of two groups showed no significant differences (p > .05). However, after treatment, the levels of 24 h urine protein and the levels of serum cholesterol decreased and the levels of serum albumin increased markedly in both groups, relative to pretreatment data.…”

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confidence: 99%

“…This is consistent with the results of previous international results. 27 LEF combined with glucocorticosteroids would be a wise alternative choice for patients with refractory nephritic syndrome. LEF has a certain efficacy and displays few adverse reactions in the treatment of refractory NS.…”

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confidence: 99%

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Efficacy of leflunomide combined with prednisone in the treatment of refractory nephrotic syndrome

Liu

Chen

et al. 2016

Renal Failure

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Objective: To assess the safety and clinical efficacy of leflunomide (LEF) and prednisone on refractory nephrotic syndrome (RNS). Methods: A total of 52 patients with RNS were treated for 24 weeks between 2010 and 2014 in our hospital. In the treated group, 26 patients were treated with LEF and prednisone, and, in the control group, 26 patients were treated with cyclophosphamide (CTX) and prednisone. During the treatment, 24 h urinary protein excretion and the serum levels of albumin and cholesterol, and kidney function were assayed before and after the therapy. Adverse reactions during treatment were recorded. Results: In the LEF group, the medication was markedly effective in eight cases and effective in nine cases; the total efficacy rate was 65.30%. In the CTX group, the treatment was markedly effective in six cases and effective in nine cases; the total efficacy rate was 57%. There were no significant differences between the results of the total efficacy rate (p > .05). The 24 h urinary protein excretion and serum cholesterol levels in both groups decreased after therapy and the serum levels of albumin in both groups increased after therapy. There were significant differences between the results for the 24 h urinary protein excretion, serum levels of albumin and cholesterol in the two groups (p < .05). The treatments were well tolerated in both groups. Conclusion: LEF combined with prednisone has a certain efficacy on the RNS and displays few adverse reactions. A large-sample, randomized double-blind controlled study and long-term follow-up are needed to verify the efficacy of LEF combined with prednisone. ARTICLE HISTORY

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Efficacy of leflunomide combined with prednisone in the treatment of refractory nephrotic syndrome

Liu

Chen

et al. 2016

Renal Failure

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“…In this issue, Yang et al . presented a small retrospective, uncontrolled study analyzing LEF plus oral prednisone in the treatment of patients with IMN with nephrotic syndrome . Their work highlights that LEF therapy may lead to higher remission rates compared to non‐immunosuppressive therapy.…”

mentioning

confidence: 99%

“…However, the definitive role of LEF can only be proven with properly conducted comparative trials and that it is difficult to read too much into the Yang et al . study …”

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Leflunomide in idiopathic membranous nephropathy: A new immunosuppressive with promising treatment potential

2013

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Methaemoglobinaemia associated with trimethoprim/sulfamethoxazole treatment on a background of leflunomide‐induced pneumonitis

Klusak

Truloff

2015

Pharmacy Practice and Res

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Background Immunomodulating drugs such as leflunomide are known to be associated with immunosuppression and infection. Off‐label use of such agents may place patients at increased risk of potentially unforeseen adverse effects not commonly observed in clinical trials. Aim To describe a case of leflunomide‐induced pneumonitis, which may have contributed to the development of Pneumocystis jirovecii pneumonia (PJP). Treatment of the infection with trimethoprim/sulfamethoxazole (TMP‐SMX) in this case was associated with the development of methaemoglobinaemia, a relatively rare adverse effect associated with this agent. Clinical details A 72‐year‐old female presented with a 2‐week history of progressive dyspnoea and orthopnoea with a background of newly diagnosed, biopsy proven, membranous glomerulonephropathy. She had recently started leflunomide and prednisolone for resistant proteinuria. Soon after admission, her respiratory status deteriorated with tachypnoea (30–40/min) and hypoxia requiring large amounts of supplemental oxygen (oxygen saturation (SaO2) 95%, partial pressure of oxygen (PO2) 68 mmHg with 10 L/min of oxygen). A chest X‐ray and computed tomography revealed diffuse bilateral ground glass opacities with multimodal consolidation. Sputum polymerase chain reaction testing was positive for P. jirovecii, and a diagnosis of PJP was made. Subsequent treatment with primaquine and TMP‐SMX was linked to the development of drug‐induced methaemoglobinaemia (MeHb). Outcome The antimicrobial regime was changed to intravenous (IV) pentamidine as an alternative treatment for P. jirovecii pneumonia. Despite this, there was further deterioration associated with a suspected secondary bacterial pneumonia. Additional IV antibiotics were added, including piperacillin/tazobactam and vancomycin. Following failure to respond to this treatment, active interventions were withdrawn after family discussions. Palliative care measures were implemented and she died 4 days later. Conclusion Pharmacists should be aware of the potential for serious, rare adverse effects associated with immunomodulating drugs. Patients must be informed of the risks associated with treatment and the evidence for benefit when these drugs are prescribed for off‐label use. PJP pneumonia prophylaxis should be considered for patients commencing high dose, chronic corticosteroid therapy. Methaemoglobin should be measured for patients who become significantly hypoxic after treatment with trimethoprim/sulfamethoxazole.

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Leflunomide plus oral prednisone in treatment of idiopathic membranous nephropathy: A retrospective clinical study of efficacy and safety

Abstract: LEF plus oral prednisone may be an alternative treatment option in Chinese patients with nephrotic IMN.

Cited by 12 publications

References 26 publications

Efficacy of leflunomide combined with prednisone in the treatment of refractory nephrotic syndrome

Efficacy of leflunomide combined with prednisone in the treatment of refractory nephrotic syndrome

Leflunomide in idiopathic membranous nephropathy: A new immunosuppressive with promising treatment potential

Methaemoglobinaemia associated with trimethoprim/sulfamethoxazole treatment on a background of leflunomide‐induced pneumonitis

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