Repeated pulses of methyl-prednisolone with reduced doses of prednisone improve the outcome of class III, IV and V lupus nephritis: An observational comparative study of the Lupus-Cruces and lupus-Bordeaux cohorts

Ruiz‐Irastorza, Guillermo; Ugarte, Amaia; Terrier, Claire; Lazaro, Estibaliz; Iza, Amalur; Couzi, Lionel; Saenz, Ramon; Richez, Christophe; Porta, Sabrina; Blanco, Patrick

doi:10.1016/j.autrev.2017.05.017

Cited by 65 publications

(46 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Risks are substantially increased at continuous GC doses above 7.5 mg/day, with some studies suggesting that also lower doses might be harmful 17 42–44. To this end, two approaches can be considered: (1) use of pulses of intravenous methylprednisolone (MP) of various doses (depending on severity and body weight), which take advantage of the rapid non-genomic effects of GC45 and may allow for a lower starting dose and faster tapering of PO GC,46 47 and (2) early initiation of IS agents, to facilitate tapering and eventual discontinuation of oral GC ( see below ). High-dose intravenous MP (usually 250–1000 mg/day for 3 days) is often used in acute, organ-threatening disease (eg, renal, neuropsychiatric) after excluding infections 48…”

Section: Resultsmentioning

confidence: 99%

2019 update of the EULAR recommendations for the management of systemic lupus erythematosus

Fanouriakis

Kostopoulou

Alunno

et al. 2019

Annals of the Rheumatic Diseases

1,561

1,286

View full text Add to dashboard Cite

Our objective was to update the EULAR recommendations for the management of systemic lupus erythematosus (SLE), based on emerging new evidence. We performed a systematic literature review (01/2007–12/2017), followed by modified Delphi method, to form questions, elicit expert opinions and reach consensus. Treatment in SLE aims at remission or low disease activity and prevention of flares. Hydroxychloroquine is recommended in all patients with lupus, at a dose not exceeding 5 mg/kg real body weight. During chronic maintenance treatment, glucocorticoids (GC) should be minimised to less than 7.5 mg/day (prednisone equivalent) and, when possible, withdrawn. Appropriate initiation of immunomodulatory agents (methotrexate, azathioprine, mycophenolate) can expedite the tapering/discontinuation of GC. In persistently active or flaring extrarenal disease, add-on belimumab should be considered; rituximab (RTX) may be considered in organ-threatening, refractory disease. Updated specific recommendations are also provided for cutaneous, neuropsychiatric, haematological and renal disease. Patients with SLE should be assessed for their antiphospholipid antibody status, infectious and cardiovascular diseases risk profile and preventative strategies be tailored accordingly. The updated recommendations provide physicians and patients with updated consensus guidance on the management of SLE, combining evidence-base and expert-opinion.

show abstract

Section: Resultsmentioning

confidence: 99%

2019 update of the EULAR recommendations for the management of systemic lupus erythematosus

Fanouriakis

Kostopoulou

Alunno

et al. 2019

Annals of the Rheumatic Diseases

1,561

1,286

View full text Add to dashboard Cite

show abstract

“…Intravenous methylprednisolone combined with reduced dose oral prednisone produced similar complete renal remission rates when combined with cyclophosphamide. 24 Steroid-free cyclophosphamide regimes have also shown comparable rates of complete remission in observational data. 25 This, in addition to the association demonstrated in this study between steroid exposure and infection risk, underscores the importance of establishing further evidence for reduced dose steroid regimens in treating LN.…”

Section: Lupus Nephritismentioning

confidence: 97%

Multicentre retrospective cohort study assessing the incidence of serious infections in patients with lupus nephritis, compared with non-renal systemic lupus erythematosus

Yates

Mon

et al. 2020

Lupus Sci Med

View full text Add to dashboard Cite

ObjectivesThe incidence of serious infections is poorly defined in patients with lupus nephritis (LN). It is also unclear if LN influences risk of serious infections in a longitudinal analysis. The aim of this study was to determine the incidence of serious infections in patients with SLE and LN, compared with patients with SLE without LN.MethodsA multicentre retrospective cohort study was conducted. Patients with LN identified at two tertiary centres were matched where possible with age and gender-matched patients with SLE without LN.Any infection requiring inpatient admission, occurring in the 6 months following index clinical visit, was considered serious. Cox regression was employed to investigate the association between risk of serious infection and LN status, and other relevant covariates.ResultsA total of 173 patients were included within the analysis (n=87 LN, n=86 SLE only). A total of 9.2% (n=8) of patients with LN experienced at least one serious infection within the study period, compared with 5.8% (n=5) of patients without LN, equivalent to 19.5 and 12.0 infections per 100 patient-years with and without LN, respectively. Univariable and multivariable analyses found no significant increased risk of serious infection in patients with LN versus controls (HR 1.61; 95% CI 0.53 to 4.92 and adjusted HR (aHR) 0.91; 95% CI 0.27 to 3.06, respectively). Increased prednisone dose and modified SLE comorbidity index were strongly associated with serious infection (aHR (per 5 mg) 1.21; 95% CI 1.07 to 1.37; p=0.003 and aHR 1.13; 95% CI 1.02 to 1.25; p=0.018, respectively).ConclusionsIn this cohort, adjusting for cofactors, the presence of LN alone does not appear to increase the risk of serious infections compared with patients with SLE without LN. However, increased prednisone dose at baseline visit and increasing comorbidity were independently associated with the incidence of serious infection.

show abstract

“…116 Therefore, although not possible for all patients, an attempt to minimize corticosteroids (e.g., prednisone equivalent #5 mg/d) during LN maintenance therapy, should be made. Regimens with reduced or no oral corticosteroids and rapid tapering protocols are under investigation 93,117,118…”

Section: Treatmentmentioning

confidence: 99%

Management and treatment of glomerular diseases (part 2): conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Rovin

Caster

Cattran

et al. 2019

Kidney International

148

View full text Add to dashboard Cite

In November 2017, the Kidney Disease: Improving Global Outcomes (KDIGO) initiative brought a diverse panel of experts in glomerular diseases together to discuss the 2012 KDIGO glomerulonephritis guideline in the context of new developments and insights that had occurred over the years since its publication. During this KDIGO Controversies Conference on Glomerular Diseases, the group examined data on disease pathogenesis, biomarkers, and treatments to identify areas of consensus and areas of controversy. This report summarizes the discussions on primary podocytopathies, lupus nephritis, anti-neutrophil cytoplasmic antibody-associated nephritis, complementmediated kidney diseases, and monoclonal gammopathies of renal significance.

show abstract

Repeated pulses of methyl-prednisolone with reduced doses of prednisone improve the outcome of class III, IV and V lupus nephritis: An observational comparative study of the Lupus-Cruces and lupus-Bordeaux cohorts

Cited by 65 publications

References 28 publications

2019 update of the EULAR recommendations for the management of systemic lupus erythematosus

2019 update of the EULAR recommendations for the management of systemic lupus erythematosus

Multicentre retrospective cohort study assessing the incidence of serious infections in patients with lupus nephritis, compared with non-renal systemic lupus erythematosus

Management and treatment of glomerular diseases (part 2): conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Contact Info

Product

Resources

About