The 10-year follow-up data of the Euro-Lupus Nephritis Trial comparing low-dose and high-dose intravenous cyclophosphamide

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

doi:10.1136/ard.2008.102533

Cited by 476 publications

(307 citation statements)

References 17 publications

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“…These figures in the worst-case scenario were 79%, 70%, and 66%, respectively. These are 10% lower compared to studies from the westerndeveloped nations as well as Asian-developed countries such as Hong Kong and Japan (2,3,(5)(6)(7)(8). However, these are much better than those reported from our country previously.…”

Section: Discussioncontrasting

confidence: 79%

“…Absence of remission and occurrence of a major infection remained significant on multivariate analyses. Failure of induction has consistently been the most important factor that determines prognosis in studies on outcomes including prospective trials, such as Euro-Lupus Nephritis Trial (3)(4)(5)(6)(7)10,17,20). Similarly, many studies have found serum creatinine at onset and hypertension to be important prognostic factors (4,6,7,17,19).…”

Section: Discussionmentioning

confidence: 99%

“…Impressive gains in outcome have been possible with immunosuppressive regimens, with recent studies from North America and Europe reporting a 10-year renal survival of 80 -90%, and some even maintaining normal renal function in 90% (2)(3)(4)(5). Developed countries in Asia, in particular Japan and Hong Kong, have matched these outcomes (6 -8).…”

Section: Introductionmentioning

confidence: 99%

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Long‐term outcome of lupus nephritis in Asian Indians

Dhir¹,

Aggarwal²,

Lawrence³

et al. 2012

Arthritis Care & Research

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Objective. There are sparse data on outcome of lupus nephritis from developing countries. This study looks at outcome in Asian Indians. Methods. This retrospective study included patients at a single center over 20 years. Patients were treated as per standard protocols. The primary outcome measure was chronic renal failure or death; the secondary outcome was end-stage renal disease or death. The worst-case scenario was also calculated, considering those lost to followup in the first year as events. Kaplan-Meier survival curves and the log rank test were used for survival analysis. Data are shown as the mean ؎ SD. Results. We included 188 patients with lupus nephritis, with a female:male ratio of 11:1, a mean ؎ SD age at onset of 23.6 ؎ 10.5 years, and a median followup time of 6 years (interquartile range 3-9 years). Of 136 patients with a biopsy sample, the distribution was as follows: class II in 22, class III in 36, class IV in 61, class V in 16, and class VI in 1. Survival with normal renal function was 84%, 69%, and 57% at 5, 10, and 15 years, respectively; in the worst-case scenario, survival was 77%, 63%, and 51%, respectively. There was no difference in survival by histologic class; however, nonbiopsied patients had lower survival. Renal survival was 91%, 81%, and 76% at 5, 10, and 15 years, respectively; in the worst-case scenario, survival was 79%, 70%, and 66%, respectively. Risk factors for poor outcome were low C3, hematuria, hypertension, creatinine, lack of remission, and occurrence of major infection. There was a high rate of major infections of 42.3%, with tuberculosis at 11.5%. Infections caused one-half of all deaths. Conclusion. The outcome of lupus nephritis in Asian Indians with standard immunosuppressive regimens is reasonable, but immunosuppression is associated with a high rate of infection.

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Section: Discussioncontrasting

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Long‐term outcome of lupus nephritis in Asian Indians

Dhir¹,

Aggarwal²,

Lawrence³

et al. 2012

Arthritis Care & Research

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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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“…Standardtherapie für die schwere Lupusnephritis ist weiterhin Cyclophosphamid, allerdings in der reduzierten Euro-Lupus-Dosis von insgesamt 3 g (6 × 500 mg) Gesamtdosis [22,23]. Darunter ist das Risiko des irreversiblen Ovarialversagens offenbar verringert.…”

Section: Nephritis Und Zns-beteiligungunclassified

Systemischer Lupus erythematodes

Aringer

Schneider

2016

Akt Rheumatol

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Die Klassifikationskriterien des American College of Rheumatology (ACR) [1,2] haben über Jahrzehnte unser Verständnis des SLE wesentlich mitgeprägt. In einem Versuch, näher an auch diagnostisch verwertbare Charakteristika heranzukommen, haben die Kriterien der Systemic Lupus Cooperating Clinics (SLICC)-Gruppe die Sensitivität auf Kosten der Spezifität deutlich erhöht [3]. Aber beide Sets sind nicht für die Diagnose gemacht und sollten dafür auch nicht missbraucht werden -auch, weil sie zu viele Fehlermöglich-keiten haben. Obwohl momentan mit Hochdruck an noch besseren Klassifikationskriterien gearbeitet wird, wird sich an dieser Situation nichts Fundamentales ändern.Was macht also die Diagnose SLE aus? Der Verdacht auf die Erkrankung sollte aufkommen, wenn typische Manifestationen (Haut, Arthritis, Niere,…) auftreten, wenn eine nicht erklärte Multi-Systemerkrankung vorliegt, oder Patienten unter länger andauernden Myalgien oder Arthralgien leiden und serologische Befunde (erhöhte BSG, Komplementverbrauch) vorliegen. Fast immer sind bei einem SLE die ANA positiv [4]. Allerdings ist hier unbedingt die Immunfluoreszenz auf Hep2-Zellen zu fordern [5]; Die ELISA-Verfahren sind weder in ihrer Sensitivität, noch in ihrer Spezifität vergleichbar. AbStr Ac tToday's therapeutic options and concepts have greatly improved the chances of SLE patients to live a long and good life with lupus erythematosus. However, this is the very reason why SLE continues to be a considerable challenge for physicians. The broad spectrum of possible organ involvement requires every rheumatologist to be a "full-blooded" internal medicine specialist. Flares, infections and vascular events usually cannot be ruled out in the long run and necessitate vigilance both on the patient's and the physician's side. In addition, psychological factors often have a significant impact on the overall picture. Nevertheless, simple and straightforward rules can be formulated for most situations, as was done for rheumatoid arthritis (RA). This review aims to outline these rules. 285Dieses Dokument wurde zum persönlichen Gebrauch heruntergeladen. Vervielfältigung nur mit Zustimmung des Verlages. Auch für die weiterführende serologische Diagnostik ist die Spezifität kritisch. Während Anti-Sm-Antikörper weitgehend SLE-spezifisch (99 %) sind, sind Anti-Ro-Antikörper beim Sjögren-Syndrom die Regel und kommen bei Systemischer Sklerose vor. Anti-dsDNAAntikörper sind recht spezifisch (96 %), wenn der Test spezifisch ist (CLIFT, RIA), aber Anti-dsDNA-Antikörper im ELISA sind leider meist sehr unspezifisch. Anti-U1RNP-Antikörper kommen isoliert bei der MCTD vor, sprechen aber in Kombination mit anderen Antikörpern für einen SLE. Anti-Phospholipid-Antikörper kommen etwas gleich häufig mit und ohne SLE vor -und gehen häufig mit positiven ANA einher (▶Abb. 1).Von den Organmanifestationen ist nur die histologisch gesicherte Lupus-Nephritis in der Regel spezifisch genug, um alleine darauf eine Diagnose aufzubauen [3]. Hautmanifestationen können auch isoliert als Haut-Lupus vorl...

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The 10-year follow-up data of the Euro-Lupus Nephritis Trial comparing low-dose and high-dose intravenous cyclophosphamide

Abstract: The data confirm that a LD IVCY regimen followed by AZA-the "Euro-Lupus regimen"-achieves good clinical results in the very long term.

Cited by 476 publications

References 17 publications

Long‐term outcome of lupus nephritis in Asian Indians

Long‐term outcome of lupus nephritis in Asian Indians

Predictive Factors and Long Term Outcome in Lupus Nephritis in Libya

Systemischer Lupus erythematodes

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