1
|
Guo Q, Zhang X, Sun S, Tang X, Shen W, Liang J, Yao G, Geng L, Ding S, Chen H, Wang H, Hua B, Zhang H, Wang D, Feng X, Sun L, Jin Z. Association Between Mycophenolate Mofetil Use and Subsequent Infections Among Hospitalized Patients with Systemic Lupus Erythematosus: A Nested Case-Control Study. Rheumatol Ther 2023; 10:1535-1554. [PMID: 37742321 PMCID: PMC10654301 DOI: 10.1007/s40744-023-00595-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 08/22/2023] [Indexed: 09/26/2023] Open
Abstract
INTRODUCTION The association between mycophenolate mofetil (MMF) and infection in patients with systemic lupus erythematosus (SLE) has not been clarified. This study evaluated the degree and factors in effect of MMF use on infection in patients with SLE. METHODS A hospitalized-based observational study was conducted to collect medical records on patients with SLE during 2010-2021. A nested case-control study was performed among 3339 patients with SLE, including 1577 cases and 1762 controls by whether they developed any type of infection. The exposure of MMF use was determined within 1 year before diagnosed infection or the end of follow-up. Logistic regression was used to estimate the odds ratio (OR) and 95% confidence interval (CI) for association between MMF and subsequent infection. RESULTS MMF was significantly associated with the risk of overall infection (adjusted OR 1.90, 95% CI 1.48-2.44) and different types of infections, including bacterial infection (adjusted OR 2.07, 95% CI 1.55-2.75), viral infection (adjusted OR 1.92, 95% CI 1.23-3.01), and opportunistic infection (adjusted OR 2.13, 95% CI 1.31-3.46). The top three risks of specific types of infections were bacteremia/septicemia, urinary tract infection/pyelonephritis, and herpes zoster. Stratification analysis showed risk of overall infection increased especially in MMF users with age over 55 years, diabetes, central nervous system involvement, and thrombocytopenia. Moreover, the risk of infection increased with increasing dosage and duration of MMF use. Additionally, the combination of MMF with CYC and other immunosuppressants significantly increases the risk of infections compared to using a single one. CONCLUSIONS MMF use is associated with various type of infections in patients with SLE, particularly in those with longer use, older age, complications with comorbidities, and concomitant use of CYC or other immunosuppressants.
Collapse
Affiliation(s)
- Qingqing Guo
- Department of Rheumatology and Immunology, China Pharmaceutical University Nanjing Drum Tower Hospital, 321 Zhongshan Road, Nanjing, 210008, China
| | - Xueyi Zhang
- Department of Rheumatology and Immunology, China Pharmaceutical University Nanjing Drum Tower Hospital, 321 Zhongshan Road, Nanjing, 210008, China
| | - Siqin Sun
- Department of Rheumatology and Immunology, China Pharmaceutical University Nanjing Drum Tower Hospital, 321 Zhongshan Road, Nanjing, 210008, China
| | - Xiaojun Tang
- Department of Rheumatology and Immunology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, China
| | - Wei Shen
- Department of Rheumatology and Immunology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, China
| | - Jun Liang
- Department of Rheumatology and Immunology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, China
| | - Genhong Yao
- Department of Rheumatology and Immunology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, China
| | - Linyu Geng
- Department of Rheumatology and Immunology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, China
| | - Shuai Ding
- Department of Rheumatology and Immunology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, China
| | - Hongwei Chen
- Department of Rheumatology and Immunology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, China
| | - Hong Wang
- Department of Rheumatology and Immunology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, China
| | - Bingzhu Hua
- Department of Rheumatology and Immunology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, China
| | - Huayong Zhang
- Department of Rheumatology and Immunology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, China
| | - Dandan Wang
- Department of Rheumatology and Immunology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, China
| | - Xuebing Feng
- Department of Rheumatology and Immunology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, China
| | - Lingyun Sun
- Department of Rheumatology and Immunology, China Pharmaceutical University Nanjing Drum Tower Hospital, 321 Zhongshan Road, Nanjing, 210008, China.
- Department of Rheumatology and Immunology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, China.
- Rheumatology Medical Center and Stem Cell Intervention Center, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, 210008, China.
| | - Ziyi Jin
- Department of Rheumatology and Immunology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, China.
- Rheumatology Medical Center and Stem Cell Intervention Center, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, 210008, China.
| |
Collapse
|
2
|
Fang T, Li B, Li M, Zhang Y, Jing Z, Li Y, Xue T, Zhang Z, Fang W, Lin Z, Meng F, Li L, Yang Y, Zhang X, Liang X, Chen SN, Chen J, Zhang X. Engineered Cell Membrane Vesicles Expressing CD40 Alleviate System Lupus Nephritis by Intervening B Cell Activation. SMALL METHODS 2023; 7:e2200925. [PMID: 36605001 DOI: 10.1002/smtd.202200925] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 12/17/2022] [Indexed: 06/17/2023]
Abstract
Immune intervention of B cell activation to blockade the production of autoantibodies provokes intense interest in the field of systemic lupus erythematosus (SLE) therapy development. Although the survival rate for SLE is improved, many patients die untimely. Engineered cell membrane vesicles manifest remarkable capacity of targeted drug delivery and immunomodulation of immune cells such as B cells. Herein, this work engineered cellular nanovesicles (NVs) presenting CD40 (CD40 NVs) that can blunt B cells and thus alleviate SLE. CD40 NVs disrupt the CD40/CD40 ligand (CD40L) costimulatory signal axis through the blockade of CD40L on CD4+ T cells. Therefore, the CD40 NVs restrain the generation of the germinal center structure and production of antibodies from B cells. Furthermore, immunosuppressive drug mycophenolate mofetil (MMF) is also encapsulated in the vesicles (MMF-CD40 NVs), which is employed to deplete immunocytes including B cells, T cells, and dendritic cells. Together, CD40 NVs are promising formulations for relieving autoimmunity and lupus nephritis in MRL/lpr mice.
Collapse
Affiliation(s)
- Tianliang Fang
- Department of Pharmacology, Molecular Cancer Research Center, School of Medicine, Shenzhen Campus of Sun Yat-sen University, Sun Yat-sen University, Shenzhen, Guangdong, 518107, China
| | - Baoqi Li
- Department of Pharmacology, Molecular Cancer Research Center, School of Medicine, Shenzhen Campus of Sun Yat-sen University, Sun Yat-sen University, Shenzhen, Guangdong, 518107, China
| | - Meng Li
- Department of Dermatology, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, 200011, China
| | - Yuli Zhang
- Department of Pharmacology, Molecular Cancer Research Center, School of Medicine, Shenzhen Campus of Sun Yat-sen University, Sun Yat-sen University, Shenzhen, Guangdong, 518107, China
| | - Zhangyan Jing
- Department of Pharmacology, Molecular Cancer Research Center, School of Medicine, Shenzhen Campus of Sun Yat-sen University, Sun Yat-sen University, Shenzhen, Guangdong, 518107, China
| | - Yuan Li
- Department of Pharmacology, Molecular Cancer Research Center, School of Medicine, Shenzhen Campus of Sun Yat-sen University, Sun Yat-sen University, Shenzhen, Guangdong, 518107, China
| | - Tianyuan Xue
- Department of Pharmacology, Molecular Cancer Research Center, School of Medicine, Shenzhen Campus of Sun Yat-sen University, Sun Yat-sen University, Shenzhen, Guangdong, 518107, China
| | - Zhirang Zhang
- Department of Pharmacology, Molecular Cancer Research Center, School of Medicine, Shenzhen Campus of Sun Yat-sen University, Sun Yat-sen University, Shenzhen, Guangdong, 518107, China
| | - Wenli Fang
- Department of Pharmacology, Molecular Cancer Research Center, School of Medicine, Shenzhen Campus of Sun Yat-sen University, Sun Yat-sen University, Shenzhen, Guangdong, 518107, China
| | - Zhongda Lin
- Department of Pharmacology, Molecular Cancer Research Center, School of Medicine, Shenzhen Campus of Sun Yat-sen University, Sun Yat-sen University, Shenzhen, Guangdong, 518107, China
| | - Fanqiang Meng
- Department of Pharmacology, Molecular Cancer Research Center, School of Medicine, Shenzhen Campus of Sun Yat-sen University, Sun Yat-sen University, Shenzhen, Guangdong, 518107, China
| | - Liyan Li
- Department of Pharmacology, Molecular Cancer Research Center, School of Medicine, Shenzhen Campus of Sun Yat-sen University, Sun Yat-sen University, Shenzhen, Guangdong, 518107, China
| | - Yang Yang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200433, China
| | - Xingding Zhang
- Department of Pharmacology, Molecular Cancer Research Center, School of Medicine, Shenzhen Campus of Sun Yat-sen University, Sun Yat-sen University, Shenzhen, Guangdong, 518107, China
| | - Xin Liang
- Guangdong Provincial Key Laboratory of Medical Molecular Diagnostics, Key Laboratory of Stem Cell and Regenerative Tissue Engineering, School of Basic Medical Sciences, Guangdong Medical University, Dongguan, 523808, China
| | - Shu-Na Chen
- Department of Pharmacology, Molecular Cancer Research Center, School of Medicine, Shenzhen Campus of Sun Yat-sen University, Sun Yat-sen University, Shenzhen, Guangdong, 518107, China
| | - Jun Chen
- Department of Dermatology, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, 200011, China
| | - Xudong Zhang
- Department of Pharmacology, Molecular Cancer Research Center, School of Medicine, Shenzhen Campus of Sun Yat-sen University, Sun Yat-sen University, Shenzhen, Guangdong, 518107, China
| |
Collapse
|
3
|
Ohkubo N, Iwata S, Nakano K, Miyagawa I, Hanami K, Fukuyo S, Miyazaki Y, Kawabe A, Nakayamada S, Tanaka Y. Efficacy and Safety of High-Dose of Mycophenolate Mofetil Compared With Cyclophosphamide Pulse Therapy as Induction Therapy in Japanese Patients with Proliferative Lupus Nephritis. Mod Rheumatol 2021; 32:1077-1085. [PMID: 34915579 DOI: 10.1093/mr/roab113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/19/2021] [Accepted: 11/16/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To clarify the effectiveness and safety of induction therapy with mycophenolate mofetil (MMF) in patients with lupus nephritis (LN). METHODS Patients with LN administered MMF (n = 35) or IVCY (n = 25) plus high-dose corticosteroids between July 2015 and June 2020 were included. MMF was increased from 2 g/day to 3 g/day, with no adverse events (AEs). The primary endpoint was the 6-month renal remission rate. Secondary endpoints were retention rate and AEs. RESULTS There were no significant differences in age, sex, disease duration, renal histological type, SLEDAI, and UPCR between the two groups. Twenty-six patients (74%) continued with MMF therapy, whereas twelve (48%) completed six IVCY courses. The retention rate was significantly higher in the MMF than in the IVCY group (p = 0.048). Twenty-four and fourteen patients in MMF and IVCY groups, respectively, achieved renal remission with insignificant differences. Grade 3 or higher AEs were observed in eight and fourteen patients in the MMF and IVCY groups, respectively (p = 0.014). CONCLUSIONS The efficacy of high-dose MMF was comparable to that of IVCY in Japanese patients with proliferative LN, with fewer AEs and a higher retention rate than IVCY, suggesting the high tolerability of MMF.
Collapse
Affiliation(s)
- Naoaki Ohkubo
- The First Department of Internal Medicine, School of Medicine, University of Occupational & Environmental Health, Kitakyushu, Japan
| | - Shigeru Iwata
- The First Department of Internal Medicine, School of Medicine, University of Occupational & Environmental Health, Kitakyushu, Japan
| | - Kazuhisa Nakano
- The First Department of Internal Medicine, School of Medicine, University of Occupational & Environmental Health, Kitakyushu, Japan
| | - Ippei Miyagawa
- The First Department of Internal Medicine, School of Medicine, University of Occupational & Environmental Health, Kitakyushu, Japan
| | - Kentaro Hanami
- The First Department of Internal Medicine, School of Medicine, University of Occupational & Environmental Health, Kitakyushu, Japan
| | - Shunsuke Fukuyo
- The First Department of Internal Medicine, School of Medicine, University of Occupational & Environmental Health, Kitakyushu, Japan
| | - Yusuke Miyazaki
- The First Department of Internal Medicine, School of Medicine, University of Occupational & Environmental Health, Kitakyushu, Japan
| | - Akio Kawabe
- The First Department of Internal Medicine, School of Medicine, University of Occupational & Environmental Health, Kitakyushu, Japan
| | - Shingo Nakayamada
- The First Department of Internal Medicine, School of Medicine, University of Occupational & Environmental Health, Kitakyushu, Japan
| | - Yoshiya Tanaka
- The First Department of Internal Medicine, School of Medicine, University of Occupational & Environmental Health, Kitakyushu, Japan
| |
Collapse
|
4
|
Olivieri G, Ceccarelli F, Natalucci F, Pirone C, Orefice V, Pacucci VA, Garufi C, Truglia S, Spinelli FR, Alessandri C, Conti F. Five-years drug survival of mycophenolate mofetil therapy in patients with systemic lupus erythematosus: Comparison between renal and non-renal involvement. Joint Bone Spine 2021; 88:105246. [PMID: 34171464 DOI: 10.1016/j.jbspin.2021.105246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/09/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The EULAR recommendations underline the use of MMF for Lupus Nephritis (LN) but also for the treatment of moderate/severe non-renal manifestations (NLN). This study aims at evaluating the 5-years drug retention rate (DRR) of MMF in a SLE cohort in a real-life scenario. Secondly, we investigated the MMF influence to control chronic damage progression. METHODS We performed a longitudinal study including all the SLE patients starting MMF in our Lupus Clinic (from 2008 to 2020). The DRR was estimated using the Kaplan-Meier method. RESULTS We evaluated 162 SLE patients (M/F 22/140). The most frequent indications for prescribing MMF were LN (101 patients, 62.3%) and musculoskeletal manifestations (39, 24.1%) followed by NPSLE (10, 6.2%) and other manifestations (12, 7.4%). We registered a median treatment duration of 30 months (IQR 55). At 60 months follow-up we observed a DRR of 61.1% for LN patients, which was similar to that registered for patients without renal involvement (60.5%). The DRR was higher in the subgroup of patients with joint involvement (75.4%, P non-significant). During the overall observation period, 92 patients (59.2%) discontinued MMF. The main cause of withdrawal was the achievement of remission, observed in 20 patients (21.7%). Moreover, MMF resulted able to control chronic damage progression, as demonstrated by the lack of significant increase in the median SDI values (baseline: 0.6, IQR 1; last: 0.93, IQR 1). CONCLUSIONS Our finding suggested that MMF is a safe and effective drug for SLE manifestations other than LN, especially for joint involvement. Moreover, it was able to control the chronic damage progression.
Collapse
Affiliation(s)
- Giulio Olivieri
- Lupus Clinic, Reumatologia, Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Sapienza Università di Roma, Viale del Policlinico 155, 00161 Roma, Italy
| | - Fulvia Ceccarelli
- Lupus Clinic, Reumatologia, Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Sapienza Università di Roma, Viale del Policlinico 155, 00161 Roma, Italy.
| | - Francesco Natalucci
- Lupus Clinic, Reumatologia, Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Sapienza Università di Roma, Viale del Policlinico 155, 00161 Roma, Italy
| | - Carmelo Pirone
- Lupus Clinic, Reumatologia, Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Sapienza Università di Roma, Viale del Policlinico 155, 00161 Roma, Italy
| | - Valeria Orefice
- Lupus Clinic, Reumatologia, Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Sapienza Università di Roma, Viale del Policlinico 155, 00161 Roma, Italy
| | - Viviana Antonella Pacucci
- Lupus Clinic, Reumatologia, Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Sapienza Università di Roma, Viale del Policlinico 155, 00161 Roma, Italy
| | - Cristina Garufi
- Lupus Clinic, Reumatologia, Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Sapienza Università di Roma, Viale del Policlinico 155, 00161 Roma, Italy
| | - Simona Truglia
- Lupus Clinic, Reumatologia, Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Sapienza Università di Roma, Viale del Policlinico 155, 00161 Roma, Italy
| | - Francesca Romana Spinelli
- Lupus Clinic, Reumatologia, Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Sapienza Università di Roma, Viale del Policlinico 155, 00161 Roma, Italy
| | - Cristiano Alessandri
- Lupus Clinic, Reumatologia, Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Sapienza Università di Roma, Viale del Policlinico 155, 00161 Roma, Italy
| | - Fabrizio Conti
- Lupus Clinic, Reumatologia, Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Sapienza Università di Roma, Viale del Policlinico 155, 00161 Roma, Italy
| |
Collapse
|
5
|
Real-World Experience of Safety of Mycophenolate Mofetil in 119 Japanese Patients with Systemic Lupus Erythematosus: A Retrospective Single-Center Study. BIOMED RESEARCH INTERNATIONAL 2021; 2021:8630596. [PMID: 33564682 PMCID: PMC7850850 DOI: 10.1155/2021/8630596] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 01/11/2021] [Accepted: 01/15/2021] [Indexed: 11/17/2022]
Abstract
Objectives Mycophenolate mofetil (MMF) is the standard treatment for lupus nephritis. In Japan, it was approved for lupus nephritis in 2015. We investigated its real-world safety and effectiveness in Japanese patients with systemic lupus erythematosus (SLE). Methods We analyzed the continuation rate, adverse events, and reasons for discontinuation of MMF in Japanese patients with SLE in a retrospective single-center study. We included 119 patients who received MMF from 31 July 2015 to 31 May 2019. To compare demographic and clinical characteristics between groups, the Mann–Whitney U-test was used for nonnormally distributed variables. Categorical variables were compared using Fisher's exact test. Kaplan–Meier curves were plotted for the discontinuation rate of MMF. Results Patients consisted of 18 males and 101 females. Thirty-five patients discontinued MMF. The cumulative discontinuation rate was 42.4%. Twenty-nine patients discontinued MMF due to adverse events, and six patients discontinued MMF due to remission of SLE or desire for childbearing. At the time of the last observation, the lupus low disease activity state achievement rate was significantly lower in patients who experienced adverse events than those who did not (64% vs. 35%, P = 0.009). We examined the concentration of mycophenolate acid (trough level) in stored frozen serum in 11 patients. Two patients had irreversible complications due to viral meningitis; their trough mycophenolate acid concentrations were 8.3 and 6.3 μg/mL, respectively. Conclusions Although MMF may be effective in Japanese patients with SLE, physicians should pay attention to infections in patients with high mycophenolate acid concentrations.
Collapse
|
6
|
Zhang H, Zhou M, Han X, Yang Y, Yu X. Mycophenolate mofetil in the treatment of Chinese patients with lupus nephritis: A PRISMA-compliant meta-analysis. Medicine (Baltimore) 2020; 99:e21121. [PMID: 32871981 PMCID: PMC7437744 DOI: 10.1097/md.0000000000021121] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUD Mycophenolate mofetil (MMF) has been recommended for the treatment of lupus nephritis (LN). Although inter-racial differences exist regarding the appropriate dose and efficacy of MMF in patients with LN, no definitive meta-analysis has yet been conducted in Chinese patients. This analysis investigated the efficacy and safety of MMF in Chinese patients with proliferative LN. METHODS A systematic literature search was conducted to select randomized controlled trials that reported at least one of the following: complete remission (CR), partial remission, total remission (TR; defined as complete remission + partial remission), relapse rate, serum creatinine, creatinine clearance, end-stage renal disease, death, infections, amenorrhea, leukopenia, alopecia, gastrointestinal symptoms, or liver damage. RESULTS Eighteen trials (927 patients) were included; 14 (750 patients) reported CR, partial remission, and TR. Two trials (58 patients) reported relapse rates during maintenance treatment. MMF induction significantly improved CR and TR vs cyclophosphamide (relative risk 1.34, 95% confidence interval: 1.13-1.58; P < .001; relative risk 1.16, 95% confidence interval: 1.02-1.33; P = .03), and was associated with significantly lower risks of infection (P < .001), amenorrhea (P < .001), leukopenia, and alopecia. No significant difference in relapse rate was evident between the MMF and azathioprine groups (P = .66). CONCLUSION According to this meta-analysis of 18 trials, MMF is significantly more effective than cyclophosphamide induction, and is associated with reduced incidences of infections, amenorrhea, leukopenia, and alopecia in Chinese patients with proliferative LN.
Collapse
Affiliation(s)
- Haitao Zhang
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing Clinical School of Second Military Medical University, Nanjing University School of Medicine, Nanjing
| | - Minlin Zhou
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing Clinical School of Second Military Medical University, Nanjing University School of Medicine, Nanjing
| | - Xiaoyan Han
- Shanghai Roche Pharmaceuticals Ltd., Shanghai, PR China
| | - Yang Yang
- Shanghai Roche Pharmaceuticals Ltd., Shanghai, PR China
| | - Xin Yu
- Shanghai Roche Pharmaceuticals Ltd., Shanghai, PR China
| |
Collapse
|
7
|
Bragazzi NL, Watad A, Damiani G, Adawi M, Amital H, Shoenfeld Y. Role of anti-DNA auto-antibodies as biomarkers of response to treatment in systemic lupus erythematosus patients: hypes and hopes. Insights and implications from a comprehensive review of the literature. Expert Rev Mol Diagn 2019; 19:969-978. [PMID: 31516059 DOI: 10.1080/14737159.2019.1665511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Due to the polymorphic clinical presentations and manifestations of systemic lupus erythematosus (SLE), biomarkers with enough diagnostic and prognostic value are of paramount importance. Recently, anti-double stranded DNA (anti-dsDNA) auto-antibodies have been proposed to monitor the response to different therapies. It has also been suggested that they should be employed as entry markers in trial studies. However, their clinical use remains still debated and, sometimes, controversial, due to conflicting findings reported. Areas covered: Through an extensive literature review, we evaluated changes in anti-dsDNA auto-antibodies levels before and after the administration of the treatment (either biological or non-biological). Expert opinion: Anti-dsDNA auto-antibodies related findings are still difficult to compare mainly because of the different detecting methods employed, even though in most studies included in this review a consistent decreasing pattern after the treatment seems to emerge. Hence, if properly standardized, anti-dsDNA auto-antibody profile may be a reliable biomarker to monitor the effectiveness of biologics as well as of non-biological drugs, especially if grouped in composite outcomes scores, such as the 'Lupus Multivariable Outcome Score' (LUMOS) or measured with other biomarkers, such as anti-nucleosome auto-antibodies. We recommend the assessment of anti-dsDNA auto-antibodies levels in both daily practice and research settings.
Collapse
Affiliation(s)
- Nicola Luigi Bragazzi
- Department of Mathematics and Statistics, Laboratory for Industrial and Applied Mathematics (LIAM) , Toronto , Canada
| | - Abdulla Watad
- Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel.,Department of Internal Medicine 'B', Sheba Medical Center , Ramat Gan , Israel
| | - Giovanni Damiani
- Centro Studi GISED, Young Dermatologists Italian Network , Bergamo , Italy.,Department of Biomedical, Surgical and Dental Sciences University of Milan , Milan , Italy.,Department of Dermatology, Case Western Reserve University , OH , Cleveland , USA.,Clinical Dermatology, IRCCS Istituto Ortopedico Galeazzi , Milan , Italy
| | - Mohammad Adawi
- Padeh and Ziv Hospitals, Azrieli Faculty of Medicine, Bar-Ilan University , Ramat Gan , Israel
| | - Howard Amital
- Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel.,Department of Internal Medicine 'B', Sheba Medical Center , Ramat Gan , Israel
| | - Yehuda Shoenfeld
- Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel.,Department of Obstetrics and Gynecology, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University) , Moscow , Russia.,Past incumbent of the Laura Schwarz-Kipp Chair for Research of Autoimmune Diseases, Tel Aviv University , Tel Aviv , Israel
| |
Collapse
|
8
|
Cyclophosphamide Versus Mycophenolate Versus Rituximab in Lupus Nephritis Remission Induction. J Clin Rheumatol 2019; 25:28-35. [DOI: 10.1097/rhu.0000000000000760] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
9
|
Defining biological subsets in systemic lupus erythematosus: progress toward personalized therapy. Pharmaceut Med 2017; 31:81-88. [PMID: 28827978 DOI: 10.1007/s40290-017-0178-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Systemic lupus erythematosus (SLE) is a heterogeneous disease with respect to disease severity, response to treatment, and organ damage. The pathogenesis of SLE includes immunological mechanisms which are driven by both genetic and environmental factors. There are clear differences in the pathogenesis of SLE between patients of different ancestral backgrounds, including differences in genetic risk factors, immunological parameters, and clinical manifestations. Patients with high vs. low levels of type I interferon (IFN) in circulation represents one major biological subset within SLE, and these two groups of patients are present in all ancestral backgrounds. Genetic factors, autoantibodies, and levels of other cytokines all differ between high and low IFN patients. This distinction has also been important in predicting response to treatment with anti-type I IFN therapies, providing a precedent in SLE for biological subsets predicting treatment response. This review will highlight some recent developments in defining biological subsets of SLE based on disease pathophysiology, and the idea that improved knowledge of disease heterogeneity will inform our efforts to personalize therapy in this disease.
Collapse
|
10
|
Chou HH, Chen MJ, Chiou YY. Enteric-coated mycophenolate sodium in pediatric lupus nephritis: a retrospective cohort study. Clin Exp Nephrol 2015; 20:628-636. [DOI: 10.1007/s10157-015-1171-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 09/22/2015] [Indexed: 02/04/2023]
|
11
|
Yap DYH, Chan TM. Lupus Nephritis in Asia: Clinical Features and Management. KIDNEY DISEASES 2015; 1:100-9. [PMID: 27536670 DOI: 10.1159/000430458] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 03/16/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND Lupus nephritis (LN) is a common and severe organ involvement manifesting itself in systemic lupus erythematosus (SLE). There is a considerable difference in prevalence, severity, treatment response and outcomes between Asian LN patients and LN patients from other racial backgrounds. SUMMARY Asian SLE patients have a higher prevalence of LN than Caucasian SLE patients and often present with a more severe disease. Increasing data from genetic studies, accompanied by progress in high-throughput genotyping, have advanced our knowledge about genetic predispositions that might partly contribute to the clinical variations observed. Corticosteroids combined with either cyclophosphamide (CYC) or mycophenolic acid (MPA) is the current standard-of-care induction regimen for severe LN irrespective of race or ethnicity. However, the preference for MPA or CYC, and possibly the optimum dose for MPA, is influenced by the patient's origin. Also, there is an insufficient evidence base for reduced-dose intravenous CYC in Asian patients. Health economics and access to prompt diagnosis and treatment are still challenging issues in some Asian regions. The former represents a significant obstacle limiting the access of patients to MPA despite the proven efficacy of the drug as an induction agent and its superiority over azathioprine (AZA) in preventing disease flares when used for long-term maintenance immunosuppression. Calcineurin inhibitors such as tacrolimus deserve further investigation in view of their additional effect on podocytes by reducing proteinuria and the promising data from Asian patients. Despite considerable advances in the clinical management of LN over the past few decades with resultant improvements in patients' outcomes, there are still knowledge gaps and unmet clinical needs. Asia has made substantial contributions to the evidence base that guides clinical management and continues to offer invaluable opportunities for research pursuits. KEY MESSAGES Treatment responses and clinical outcomes in Asian patients with LN compare favorably with patients from other parts of the world. The prevention and treatment of infective complications remain significant challenges in managing LN in Asia. FACTS FROM EAST AND WEST (1) The prevalence of SLE is lower among Caucasians than other ethnicities. A higher prevalence is observed among Asians and African Americans, while the highest prevalence is found in Caribbean people. The prevalence of LN in Asian SLE patients is much higher than in Caucasians as well. However, the 10-year renal outcome and renal survival rate appear to be better in Asians. (2) Polymorphisms of genes involved in the immune response, such as Fcγ receptor, integrin alpha M, TNF superfamily 4, myotubularin-related protein 3 and many others, might be partly responsible for the differences in prevalence between the different ethnic groups. European ancestry was shown to be associated with a decrease in the risk of LN even after adjustment for genes most associated with renal disease. (3) Access to health care is a key determinant of disease progression, treatment outcome and the management of complications such as infections, particularly in South Asia, and might also explain disparities between clinical outcomes. (4) The efficacy of low-dose CYC combined with corticosteroids for induction treatment of LN was proved in European Caucasian patients. This treatment is also used in Asia, although no formal evaluation of efficacy and safety in comparison with other treatment regimens exists in this population. The efficacy of mycophenolate mofetil (MMF) is similar to that of CYC, and similar between Asians and Caucasians. MMF may be more effective than CYC in inducing response in high-risk populations such as African American or Hispanic patients. MMF might cause less infection-related events in Asians, but its high cost prevents broader usage at present. (5) For maintenance therapy, corticosteroid combined with AZA or MMF is used worldwide, with a broadly similar efficacy of both treatments, although there are data suggesting that in high-risk populations (e.g. African Americans) MMF may be more effective in preventing renal flares. AZA is often preferred in Asia due to economic constraints and because of its safety in pregnancy. (6) Alternative therapies under investigation include rituximab, which might be more efficient in Caucasians, as well as belimumab. Recent Japanese and Chinese studies have indicated a potential benefit of tacrolimus as a substitute for or in addition to CYC or MMF (dual or triple immunosuppression). Mizoribine is used in Japan exclusively.
Collapse
Affiliation(s)
- Desmond Y H Yap
- Nephrology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, SAR, China
| | - Tak Mao Chan
- Nephrology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, SAR, China
| |
Collapse
|
12
|
Subedi A, Magder LS, Petri M. Effect of mycophenolate mofetil on the white blood cell count and the frequency of infection in systemic lupus erythematosus. Rheumatol Int 2015; 35:1687-92. [PMID: 25836768 DOI: 10.1007/s00296-015-3265-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 03/27/2015] [Indexed: 01/15/2023]
Abstract
Leukopenia is a common manifestation of SLE. Addition of immunosuppressive therapy in a SLE patient who is already leukopenic is a clinical concern. It could worsen leukopenia, increase the risk of infection, or both. The aim of this study was to analyze the immediate effect of mycophenolate mofetil on the white blood cell count and the rate of infection in SLE patients. Two hundred and forty-four patients within the Hopkins Lupus Cohort who were newly started on mycophenolate mofetil were included in the study. The white blood cell count and interval infection history on the day mycophenolate mofetil was started were compared with the white blood cell count and interval infection history at the next visit. The study was based on 244 patients who began taking mycophenolate mofetil in the cohort. The study population included 47 % African Americans, 44 % Caucasians, and 9 % other ethnicities. There was a slight but not statistically significant increase in the white blood cell count (6.63 vs. 7.01), after starting mycophenolate mofetil. Patients with a baseline white blood cell count <3000/mm(3) did have a statistically significant increase in the white blood cell count after starting mycophenolate mofetil (2.57 vs. 5.13, P = 0.0047). We also found a statistically significant increase in the risk of bacterial infection (but not viral infection) after starting mycophenolate mofetil (4 vs. 9 %, P = 0.0036). Leukopenia does not worsen with mycophenolate mofetil. However, mycophenolate mofetil appears to slightly increase the rate of bacterial (but not viral) infection.
Collapse
Affiliation(s)
- Ananta Subedi
- Department of Medicine, Thomas Jefferson University Hospital, 833 Chestnut Street, Suite 701, Philadelphia, PA, 19107, USA.
| | - Laurence S Magder
- Department of Epidemiology and Public Health, University of Maryland, 660 West Redwood Street, Baltimore, MD, 21201, USA.
| | - Michelle Petri
- Division of Rheumatology, Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 7500, Baltimore, MD, 21205, USA.
| |
Collapse
|
13
|
Liu Z, Zhang H, Liu Z, Xing C, Fu P, Ni Z, Chen J, Lin H, Liu F, He Y, He Y, Miao L, Chen N, Li Y, Gu Y, Shi W, Hu W, Liu Z, Bao H, Zeng C, Zhou M. Multitarget therapy for induction treatment of lupus nephritis: a randomized trial. Ann Intern Med 2015; 162:18-26. [PMID: 25383558 DOI: 10.7326/m14-1030] [Citation(s) in RCA: 232] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Treatment of lupus nephritis (LN) remains challenging. OBJECTIVE To assess the efficacy and safety of a multitarget therapy consisting of tacrolimus, mycophenolate mofetil, and steroid compared with intravenous cyclophosphamide and steroid as induction therapy for LN. DESIGN 24-week randomized, open-label, multicenter study. (ClinicalTrials.gov: NCT00876616). SETTING 26 renal centers in China. PATIENTS Adults (aged 18 to 65 years) with biopsy-proven LN. INTERVENTION Tacrolimus, 4 mg/d, and mycophenolate mofetil, 1.0 g/d, versus intravenous cyclophosphamide with a starting dose of 0.75 (adjusted to 0.5 to 1.0) g/m2 of body surface area every 4 weeks for 6 months. Both groups received 3 days of pulse methylprednisolone followed by a tapering course of oral prednisone therapy. MEASUREMENTS The primary end point was complete remission at 24 weeks. Secondary end points included overall response (complete and partial remission), time to overall response, and adverse events. RESULTS After 24 weeks of therapy, more patients in the multitarget group (45.9%) than in the intravenous cyclophosphamide group (25.6%) showed complete remission (difference, 20.3 percentage points [95% CI, 10.0 to 30.6 percentage points]; P < 0.001). The overall response incidence was higher in the multitarget group than in the intravenous cyclophosphamide group (83.5% vs. 63.0%; difference, 20.4 percentage points [CI, 10.3 to 30.6 percentage points]; P < 0.001), and the median time to overall response was shorter in the multitarget group (difference, -4.1 weeks [CI, -7.9 to -2.1 weeks]). Incidence of adverse events did not differ between the multitarget and intravenous cyclophosphamide groups (50.3% [91 of 181] vs. 52.5% [95 of 181]). LIMITATION The study was limited to 24 weeks of follow-up. CONCLUSION Multitarget therapy provides superior efficacy compared with intravenous cyclophosphamide as induction therapy for LN. PRIMARY FUNDING SOURCE National Basic Research Program of China, National Key Technology R&D Program.
Collapse
Affiliation(s)
- Zhihong Liu
- From Jinling Hospital, Nanjing University School of Medicine and The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; West China Hospital, Chengdu, China; Renji Hospital, Ruijin Hospital, and Huashan Hospital, Shanghai, China; The First Affiliated Hospital of Zhejiang University, Hangzhou, China; The First Affiliated Hospital of Dalian Medical University, Dalian, China
- The Second Xiangya Hospital of Central South University, Changsha, China; Shenzhen Second People's Hospital, Shenzhen, China; Daping Hospital, Chongqing, China; The Second Affiliated Hospital of Jilin University, Changchun, China; The Third Hospital of Hebei Medical University, Hebei, China; and Guangdong General Hospital, Guangdong, China
| | - Haitao Zhang
- From Jinling Hospital, Nanjing University School of Medicine and The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; West China Hospital, Chengdu, China; Renji Hospital, Ruijin Hospital, and Huashan Hospital, Shanghai, China; The First Affiliated Hospital of Zhejiang University, Hangzhou, China; The First Affiliated Hospital of Dalian Medical University, Dalian, China
- The Second Xiangya Hospital of Central South University, Changsha, China; Shenzhen Second People's Hospital, Shenzhen, China; Daping Hospital, Chongqing, China; The Second Affiliated Hospital of Jilin University, Changchun, China; The Third Hospital of Hebei Medical University, Hebei, China; and Guangdong General Hospital, Guangdong, China
| | - Zhangsuo Liu
- From Jinling Hospital, Nanjing University School of Medicine and The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; West China Hospital, Chengdu, China; Renji Hospital, Ruijin Hospital, and Huashan Hospital, Shanghai, China; The First Affiliated Hospital of Zhejiang University, Hangzhou, China; The First Affiliated Hospital of Dalian Medical University, Dalian, China
- The Second Xiangya Hospital of Central South University, Changsha, China; Shenzhen Second People's Hospital, Shenzhen, China; Daping Hospital, Chongqing, China; The Second Affiliated Hospital of Jilin University, Changchun, China; The Third Hospital of Hebei Medical University, Hebei, China; and Guangdong General Hospital, Guangdong, China
| | - Changying Xing
- From Jinling Hospital, Nanjing University School of Medicine and The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; West China Hospital, Chengdu, China; Renji Hospital, Ruijin Hospital, and Huashan Hospital, Shanghai, China; The First Affiliated Hospital of Zhejiang University, Hangzhou, China; The First Affiliated Hospital of Dalian Medical University, Dalian, China
- The Second Xiangya Hospital of Central South University, Changsha, China; Shenzhen Second People's Hospital, Shenzhen, China; Daping Hospital, Chongqing, China; The Second Affiliated Hospital of Jilin University, Changchun, China; The Third Hospital of Hebei Medical University, Hebei, China; and Guangdong General Hospital, Guangdong, China
| | - Ping Fu
- From Jinling Hospital, Nanjing University School of Medicine and The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; West China Hospital, Chengdu, China; Renji Hospital, Ruijin Hospital, and Huashan Hospital, Shanghai, China; The First Affiliated Hospital of Zhejiang University, Hangzhou, China; The First Affiliated Hospital of Dalian Medical University, Dalian, China
- The Second Xiangya Hospital of Central South University, Changsha, China; Shenzhen Second People's Hospital, Shenzhen, China; Daping Hospital, Chongqing, China; The Second Affiliated Hospital of Jilin University, Changchun, China; The Third Hospital of Hebei Medical University, Hebei, China; and Guangdong General Hospital, Guangdong, China
| | - Zhaohui Ni
- From Jinling Hospital, Nanjing University School of Medicine and The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; West China Hospital, Chengdu, China; Renji Hospital, Ruijin Hospital, and Huashan Hospital, Shanghai, China; The First Affiliated Hospital of Zhejiang University, Hangzhou, China; The First Affiliated Hospital of Dalian Medical University, Dalian, China
- The Second Xiangya Hospital of Central South University, Changsha, China; Shenzhen Second People's Hospital, Shenzhen, China; Daping Hospital, Chongqing, China; The Second Affiliated Hospital of Jilin University, Changchun, China; The Third Hospital of Hebei Medical University, Hebei, China; and Guangdong General Hospital, Guangdong, China
| | - Jianghua Chen
- From Jinling Hospital, Nanjing University School of Medicine and The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; West China Hospital, Chengdu, China; Renji Hospital, Ruijin Hospital, and Huashan Hospital, Shanghai, China; The First Affiliated Hospital of Zhejiang University, Hangzhou, China; The First Affiliated Hospital of Dalian Medical University, Dalian, China
- The Second Xiangya Hospital of Central South University, Changsha, China; Shenzhen Second People's Hospital, Shenzhen, China; Daping Hospital, Chongqing, China; The Second Affiliated Hospital of Jilin University, Changchun, China; The Third Hospital of Hebei Medical University, Hebei, China; and Guangdong General Hospital, Guangdong, China
| | - Hongli Lin
- From Jinling Hospital, Nanjing University School of Medicine and The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; West China Hospital, Chengdu, China; Renji Hospital, Ruijin Hospital, and Huashan Hospital, Shanghai, China; The First Affiliated Hospital of Zhejiang University, Hangzhou, China; The First Affiliated Hospital of Dalian Medical University, Dalian, China
- The Second Xiangya Hospital of Central South University, Changsha, China; Shenzhen Second People's Hospital, Shenzhen, China; Daping Hospital, Chongqing, China; The Second Affiliated Hospital of Jilin University, Changchun, China; The Third Hospital of Hebei Medical University, Hebei, China; and Guangdong General Hospital, Guangdong, China
| | - Fuyou Liu
- From Jinling Hospital, Nanjing University School of Medicine and The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; West China Hospital, Chengdu, China; Renji Hospital, Ruijin Hospital, and Huashan Hospital, Shanghai, China; The First Affiliated Hospital of Zhejiang University, Hangzhou, China; The First Affiliated Hospital of Dalian Medical University, Dalian, China
- The Second Xiangya Hospital of Central South University, Changsha, China; Shenzhen Second People's Hospital, Shenzhen, China; Daping Hospital, Chongqing, China; The Second Affiliated Hospital of Jilin University, Changchun, China; The Third Hospital of Hebei Medical University, Hebei, China; and Guangdong General Hospital, Guangdong, China
| | - Yongcheng He
- From Jinling Hospital, Nanjing University School of Medicine and The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; West China Hospital, Chengdu, China; Renji Hospital, Ruijin Hospital, and Huashan Hospital, Shanghai, China; The First Affiliated Hospital of Zhejiang University, Hangzhou, China; The First Affiliated Hospital of Dalian Medical University, Dalian, China
- The Second Xiangya Hospital of Central South University, Changsha, China; Shenzhen Second People's Hospital, Shenzhen, China; Daping Hospital, Chongqing, China; The Second Affiliated Hospital of Jilin University, Changchun, China; The Third Hospital of Hebei Medical University, Hebei, China; and Guangdong General Hospital, Guangdong, China
| | - Yani He
- From Jinling Hospital, Nanjing University School of Medicine and The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; West China Hospital, Chengdu, China; Renji Hospital, Ruijin Hospital, and Huashan Hospital, Shanghai, China; The First Affiliated Hospital of Zhejiang University, Hangzhou, China; The First Affiliated Hospital of Dalian Medical University, Dalian, China
- The Second Xiangya Hospital of Central South University, Changsha, China; Shenzhen Second People's Hospital, Shenzhen, China; Daping Hospital, Chongqing, China; The Second Affiliated Hospital of Jilin University, Changchun, China; The Third Hospital of Hebei Medical University, Hebei, China; and Guangdong General Hospital, Guangdong, China
| | - Lining Miao
- From Jinling Hospital, Nanjing University School of Medicine and The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; West China Hospital, Chengdu, China; Renji Hospital, Ruijin Hospital, and Huashan Hospital, Shanghai, China; The First Affiliated Hospital of Zhejiang University, Hangzhou, China; The First Affiliated Hospital of Dalian Medical University, Dalian, China
- The Second Xiangya Hospital of Central South University, Changsha, China; Shenzhen Second People's Hospital, Shenzhen, China; Daping Hospital, Chongqing, China; The Second Affiliated Hospital of Jilin University, Changchun, China; The Third Hospital of Hebei Medical University, Hebei, China; and Guangdong General Hospital, Guangdong, China
| | - Nan Chen
- From Jinling Hospital, Nanjing University School of Medicine and The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; West China Hospital, Chengdu, China; Renji Hospital, Ruijin Hospital, and Huashan Hospital, Shanghai, China; The First Affiliated Hospital of Zhejiang University, Hangzhou, China; The First Affiliated Hospital of Dalian Medical University, Dalian, China
- The Second Xiangya Hospital of Central South University, Changsha, China; Shenzhen Second People's Hospital, Shenzhen, China; Daping Hospital, Chongqing, China; The Second Affiliated Hospital of Jilin University, Changchun, China; The Third Hospital of Hebei Medical University, Hebei, China; and Guangdong General Hospital, Guangdong, China
| | - Ying Li
- From Jinling Hospital, Nanjing University School of Medicine and The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; West China Hospital, Chengdu, China; Renji Hospital, Ruijin Hospital, and Huashan Hospital, Shanghai, China; The First Affiliated Hospital of Zhejiang University, Hangzhou, China; The First Affiliated Hospital of Dalian Medical University, Dalian, China
- The Second Xiangya Hospital of Central South University, Changsha, China; Shenzhen Second People's Hospital, Shenzhen, China; Daping Hospital, Chongqing, China; The Second Affiliated Hospital of Jilin University, Changchun, China; The Third Hospital of Hebei Medical University, Hebei, China; and Guangdong General Hospital, Guangdong, China
| | - Yong Gu
- From Jinling Hospital, Nanjing University School of Medicine and The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; West China Hospital, Chengdu, China; Renji Hospital, Ruijin Hospital, and Huashan Hospital, Shanghai, China; The First Affiliated Hospital of Zhejiang University, Hangzhou, China; The First Affiliated Hospital of Dalian Medical University, Dalian, China
- The Second Xiangya Hospital of Central South University, Changsha, China; Shenzhen Second People's Hospital, Shenzhen, China; Daping Hospital, Chongqing, China; The Second Affiliated Hospital of Jilin University, Changchun, China; The Third Hospital of Hebei Medical University, Hebei, China; and Guangdong General Hospital, Guangdong, China
| | - Wei Shi
- From Jinling Hospital, Nanjing University School of Medicine and The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; West China Hospital, Chengdu, China; Renji Hospital, Ruijin Hospital, and Huashan Hospital, Shanghai, China; The First Affiliated Hospital of Zhejiang University, Hangzhou, China; The First Affiliated Hospital of Dalian Medical University, Dalian, China
- The Second Xiangya Hospital of Central South University, Changsha, China; Shenzhen Second People's Hospital, Shenzhen, China; Daping Hospital, Chongqing, China; The Second Affiliated Hospital of Jilin University, Changchun, China; The Third Hospital of Hebei Medical University, Hebei, China; and Guangdong General Hospital, Guangdong, China
| | - Weixin Hu
- From Jinling Hospital, Nanjing University School of Medicine and The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; West China Hospital, Chengdu, China; Renji Hospital, Ruijin Hospital, and Huashan Hospital, Shanghai, China; The First Affiliated Hospital of Zhejiang University, Hangzhou, China; The First Affiliated Hospital of Dalian Medical University, Dalian, China
- The Second Xiangya Hospital of Central South University, Changsha, China; Shenzhen Second People's Hospital, Shenzhen, China; Daping Hospital, Chongqing, China; The Second Affiliated Hospital of Jilin University, Changchun, China; The Third Hospital of Hebei Medical University, Hebei, China; and Guangdong General Hospital, Guangdong, China
| | - Zhengzhao Liu
- From Jinling Hospital, Nanjing University School of Medicine and The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; West China Hospital, Chengdu, China; Renji Hospital, Ruijin Hospital, and Huashan Hospital, Shanghai, China; The First Affiliated Hospital of Zhejiang University, Hangzhou, China; The First Affiliated Hospital of Dalian Medical University, Dalian, China
- The Second Xiangya Hospital of Central South University, Changsha, China; Shenzhen Second People's Hospital, Shenzhen, China; Daping Hospital, Chongqing, China; The Second Affiliated Hospital of Jilin University, Changchun, China; The Third Hospital of Hebei Medical University, Hebei, China; and Guangdong General Hospital, Guangdong, China
| | - Hao Bao
- From Jinling Hospital, Nanjing University School of Medicine and The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; West China Hospital, Chengdu, China; Renji Hospital, Ruijin Hospital, and Huashan Hospital, Shanghai, China; The First Affiliated Hospital of Zhejiang University, Hangzhou, China; The First Affiliated Hospital of Dalian Medical University, Dalian, China
- The Second Xiangya Hospital of Central South University, Changsha, China; Shenzhen Second People's Hospital, Shenzhen, China; Daping Hospital, Chongqing, China; The Second Affiliated Hospital of Jilin University, Changchun, China; The Third Hospital of Hebei Medical University, Hebei, China; and Guangdong General Hospital, Guangdong, China
| | - Caihong Zeng
- From Jinling Hospital, Nanjing University School of Medicine and The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; West China Hospital, Chengdu, China; Renji Hospital, Ruijin Hospital, and Huashan Hospital, Shanghai, China; The First Affiliated Hospital of Zhejiang University, Hangzhou, China; The First Affiliated Hospital of Dalian Medical University, Dalian, China
- The Second Xiangya Hospital of Central South University, Changsha, China; Shenzhen Second People's Hospital, Shenzhen, China; Daping Hospital, Chongqing, China; The Second Affiliated Hospital of Jilin University, Changchun, China; The Third Hospital of Hebei Medical University, Hebei, China; and Guangdong General Hospital, Guangdong, China
| | - Minlin Zhou
- From Jinling Hospital, Nanjing University School of Medicine and The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; West China Hospital, Chengdu, China; Renji Hospital, Ruijin Hospital, and Huashan Hospital, Shanghai, China; The First Affiliated Hospital of Zhejiang University, Hangzhou, China; The First Affiliated Hospital of Dalian Medical University, Dalian, China
- The Second Xiangya Hospital of Central South University, Changsha, China; Shenzhen Second People's Hospital, Shenzhen, China; Daping Hospital, Chongqing, China; The Second Affiliated Hospital of Jilin University, Changchun, China; The Third Hospital of Hebei Medical University, Hebei, China; and Guangdong General Hospital, Guangdong, China
| |
Collapse
|
14
|
Rezaieyazdi Z, Tavakoli T, Khajehdaluee M, Honarmand S. Efficacy of long-term maintenance therapy with mycophenolate mofetil in lupus nephritis. SPRINGERPLUS 2014; 3:638. [PMID: 25392806 PMCID: PMC4227986 DOI: 10.1186/2193-1801-3-638] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 09/29/2014] [Indexed: 01/09/2023]
Abstract
Background Mycophenolate mofetil (MMF) has long been used to manage lupus nephritis. Despite research on its long-term efficacy, it is still warranted to conduct further investigation regarding its indications, safety and outcome. This study was intended to evaluate our proposed protocol in maintenance therapy with MMF. Twenty-four lupus nephritis patients were registered prior to their receiving 3–6 month induction therapy with monthly iv pulses of cyclophosphamide (CYC), followed by 24 month maintenance therapy using MMF and steroid. We defined end points as achievement of complete and partial remission, relapse, refractory to therapy as well as end stage renal disease (ESRD) and death. Friedman and repeated measurement tests were used to assess the effect of treatment on parameters over time. Complete renal remission was achieved in 79.16% until the end of the last follow up with an average period of 12.45 ± 7.37 months since treatment commenced. Significant statistical differences were seen regarding proteinuria, hematuria, leukocyturia, plasma creatinine, C3, C4 before and after therapy (P < 0.05): plasma creatinine and proteinurea falling from 0.96 ± 0.65 to 0.75 ± 0.19 mg/dl (P < 0.14) and from 1.64 ± 1.12 to 0.27 ± 0.60 gr/24 h (P < 0.001). By the end of 24-month, 95.8% of patients had been in remission. Four episodes of relapse ended in remission followed by retreatment. No life-threatening side effects were observed in 66.6% of patients with fourteen cases of infection (58.3%). None of them developed ESRD. Maintenance therapy with MMF was shown to yield favorable outcome with minimal complications, in treating lupus nephritis (IRCT2012071710313N1).
Collapse
Affiliation(s)
- Zahra Rezaieyazdi
- Rheumatic Diseases Research Center, Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Tahmine Tavakoli
- Internal Medicine, Brigand University of Medical Sciences, Brigand, Iran
| | | | - Shahram Honarmand
- Rheumatic Diseases Research Center, Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| |
Collapse
|
15
|
Rivera F, Mérida E, Illescas ML, López-Rubio E, Frutos MA, García-Frías P, Ramos C, Sierra M, Baltar J, Lucas J, Oliet A, Vigil A, Fernández-Juárez G, Segarra A, Praga M. Mycophenolate in refractory and relapsing lupus nephritis. Am J Nephrol 2014; 40:105-12. [PMID: 25096639 DOI: 10.1159/000365256] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 06/10/2014] [Indexed: 01/26/2023]
Abstract
BACKGROUND Mycophenolate (MF) is effective as induction and maintenance treatment in patients with lupus nephritis (LN). This study evaluates the efficacy and safety of MF in patients with refractory and relapsing LN. METHODS Data were retrospectively obtained for 85 patients (35 refractory and 50 relapsing) from 11 nephrology departments in Spain. The primary endpoints were the incidence and cumulative number of renal responses and relapses and their relationship with baseline clinical and analytical data. The secondary endpoint was the appearance of side effects. RESULTS The main clinical and analytical variables were similar both in refractory and relapsing LN. Most of the patients had received cyclophosphamide, and all of them switched to MF. 74 patients (87%) achieved a response (69% partial, 31% complete). Age at starting MF, gender, pathological classification, body mass index, blood pressure, baseline renal function, and proteinuria were not associated with achieving response. After stopping MF, 3 of 19 patients (15.7%) relapsed, all at 6 months of follow-up. No differences were found between clinical and analytical variables and number of relapses. Side effects were unremarkable, except for 1 patient, who died of thrombocytopenia and ovarian hemorrhage. CONCLUSIONS Switching to MF from other immunosuppressive treatments is effective and safe in refractory and relapsing LN.
Collapse
Affiliation(s)
- Francisco Rivera
- Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Yap DYH, Chan TM. Treatment of lupus nephritis: practical issues in Asian countries. Int J Rheum Dis 2014; 18:138-45. [DOI: 10.1111/1756-185x.12423] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Desmond Y. H. Yap
- Division of Nephrology; Department of Medicine; Queen Mary Hospital; The University of Hong Kong; Hong Kong Hong Kong
| | - Tak Mao Chan
- Division of Nephrology; Department of Medicine; Queen Mary Hospital; The University of Hong Kong; Hong Kong Hong Kong
| |
Collapse
|
17
|
Abstract
Physicians in practice should be knowledgeable regarding several aspects of autoimmune disorders, especially systemic lupus erythematosus (SLE) and lupus nephritis. These disorders can present to the clinician's clinic and private office regardless of their specialty. This review will discuss various aspects of SLE, its mechanisms of disease, role of accelerated atherosclerosis, proinflammatory cytokines, and therapeutic approaches. The role of vascular endothelial growth factor in which and plasma levels have been associated with disease activity, classification of severity, and diagnosis of lupus nephritis is addressed. Current treatment options, prognosis, and future therapeutic approaches and common side effects are also discussed.
Collapse
|
18
|
Mok CC, Yap DY, Navarra SV, Liu ZH, Zhao MH, Lu L, Takeuchi T, Avihingsanon Y, Yu XQ, Lapid EA, Lugue-Lizardo LR, Sumethkul V, Shen N, Chen SL, Chan TM. Overview of lupus nephritis management guidelines and perspective from Asia. Nephrology (Carlton) 2014; 19:11-20. [PMID: 23876069 DOI: 10.1111/nep.12136] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2013] [Indexed: 02/05/2023]
Abstract
Lupus nephritis (LN) is a common and important manifestation of systemic lupus erythematosus (SLE). Evidence suggests higher rates of lupus renal involvement in Asian populations, and maybe more severe nephritis, compared with other racial or ethnic groups. The management of LN has evolved considerably over the past three decades, based on observations from clinical studies that investigated different immunosuppressive agents including corticosteroids, cyclophosphamide, azathioprine, mycophenolic acid, calcineurin inhibitors and novel biologic therapies. This is accompanied by improvements in both the short-term treatment response rate and long-term renal function preservation. Treatment guidelines for LN have recently been issued by rheumatology and nephrology communities in U.S.A. and Europe. In view of the racial difference in disease manifestation and response to therapy, and the substantial disease burden in Asia, a panel of 15 nephrologists and rheumatologists from different Asian regions with extensive experience in lupus nephritis - the Steering Group for the Asian Lupus Nephritis Network (ALNN) - met and discussed the management of lupus nephritis in Asian patients. The group has also reviewed and deliberated on the recently published recommendations from other parts of the world. This manuscript summarizes the discussions by the group and presents consensus views on the clinical management and treatment of adult Asian patients with LN, taking into account both the available evidence and expert opinion in areas where evidence remains to be sought.
Collapse
Affiliation(s)
- Chi Chiu Mok
- Division of Rheumatology, Department of Medicine and Geriatrics, Tuen Mun Hospital, Hong Kong
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Mok CC, Yap DYH, Navarra SV, Liu ZH, Zhao MH, Lu L, Takeuchi T, Avihingsanon Y, Yu XQ, Lapid EA, Lugue-Lizardo LR, Sumethkul V, Shen N, Chen SL, Chan TM. Overview of lupus nephritis management guidelines and perspective from Asia. Int J Rheum Dis 2013; 16:625-36. [PMID: 24382275 DOI: 10.1111/1756-185x.12212] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Lupus nephritis (LN) is a common and important manifestation of systemic lupus erythematosus (SLE). Evidence suggests higher rates of lupus renal involvement in Asian populations, and maybe more severe nephritis, compared with other racial or ethnic groups. The management of LN has evolved considerably over the past three decades, based on observations from clinical studies that investigated different immunosuppressive agents including corticosteroids, cyclophosphamide, azathioprine, mycophenolic acid, calcineurin inhibitors and novel biologic therapies. This is accompanied by improvements in both the short-term treatment response rate and long-term renal function preservation. Treatment guidelines for LN have recently been issued by rheumatology and nephrology communities in U.S.A. and Europe. In view of the racial difference in disease manifestation and response to therapy, and the substantial disease burden in Asia, a panel of 15 nephrologists and rheumatologists from different Asian regions with extensive experience in lupus nephritis - the Steering Group for the Asian Lupus Nephritis Network (ALNN) - met and discussed the management of lupus nephritis in Asian patients. The group has also reviewed and deliberated on the recently published recommendations from other parts of the world. This manuscript summarizes the discussions by the group and presents consensus views on the clinical management and treatment of adult Asian patients with LN, taking into account both the available evidence and expert opinion in areas where evidence remains to be sought.
Collapse
Affiliation(s)
- Chi Chiu Mok
- Division of Rheumatology, Department of Medicine and Geriatrics, Tuen Mun Hospital, Hong Kong, Hong Kong
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Lin WH, Guo CY, Wang WM, Yang DC, Kuo TH, Liu MF, Wang MC. Incidence of progression from newly diagnosed systemic lupus erythematosus to end stage renal disease and all-cause mortality: a nationwide cohort study in Taiwan. Int J Rheum Dis 2013; 16:747-53. [PMID: 24382283 DOI: 10.1111/1756-185x.12208] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM End-stage renal disease (ESRD) is a common finding in systemic lupus erythematosus (SLE) and may contribute to mortality. The purpose of the study was to investigate the incidence of ESRD and all-cause mortality and their risk factors in patients newly diagnosed with SLE in Taiwan. METHODS This nationwide cohort study used data from the National Health Insurance Research Database. We identified 4130 newly diagnosed SLE patients at risk for ESRD during 2000-2002; among them, 103 developed ESRD by the end of 2008. Additional 412 age- and sex-matched incident ESRD non-SLE patients served as controls for the survival analysis. RESULTS Of the newly diagnosed SLE patients, 2.5% developed ESRD. Age (adjusted hazards ratio [HR] 0.66 for each 1-year increase; 95% confidence interval [CI] 0.47-0.94) and male gender (adjusted HR 2.24; 95% CI 1.4-3.6) were significantly associated with ESRD development. Survival analysis conducted after ESRD development revealed a higher mortality risk among the older patients (HR 1.04; 95% CI 1.02-1.05). Survival analysis in the younger population (age < 40 years) after ESRD development revealed a significant mortality risk among SLE patients (HR 2.73; 95% CI 1.22-6.07). CONCLUSION In the follow-up of newly diagnosed SLE patients in Taiwan, younger age and male gender were risk factors for ESRD development. After entering ESRD, these risk factors had different impacts on mortality. Despite the overall improvement in care of patients with lupus nephritis, survival is still poorer in the younger age population.
Collapse
Affiliation(s)
- Wei-Hung Lin
- Institute of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | | | | | | | | | | | | |
Collapse
|
21
|
Luijten RK, Fritsch-Stork RD, Bijlsma JW, Derksen RH. The use of glucocorticoids in Systemic Lupus Erythematosus. After 60years still more an art than science. Autoimmun Rev 2013; 12:617-28. [DOI: 10.1016/j.autrev.2012.12.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 12/02/2012] [Indexed: 01/18/2023]
|
22
|
Borchers AT, Leibushor N, Naguwa SM, Cheema GS, Shoenfeld Y, Gershwin ME. Lupus nephritis: a critical review. Autoimmun Rev 2012; 12:174-94. [PMID: 22982174 DOI: 10.1016/j.autrev.2012.08.018] [Citation(s) in RCA: 160] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2012] [Indexed: 01/18/2023]
Abstract
Lupus nephritis remains one of the most severe manifestations of systemic lupus erythematosus associated with considerable morbidity and mortality. A better understanding of the pathogenesis of lupus nephritis is an important step in identifying more targeted and less toxic therapeutic approaches. Substantial research has helped define the pathogenetic mechanisms of renal manifestations and, in particular, the complex role of type I interferons is increasingly recognized; new insights have been gained into the contribution of immune complexes containing endogenous RNA and DNA in triggering the production of type I interferons by dendritic cells via activation of endosomal toll-like receptors. At the same time, there have been considerable advances in the treatment of lupus nephritis. Corticosteroids have long been the cornerstone of therapy, and the addition of cyclophosphamide has contributed to renal function preservation in patients with severe proliferative glomerulonephritis, though at the cost of serious adverse events. More recently, in an effort to minimize drug toxicity and achieve equal effectiveness, other immunosuppressive agents, including mycophenolate mofetil, have been introduced. Herein, we provide a detailed review of the trials that established the equivalency of these agents in the induction and/or maintenance therapy of lupus nephritis, culminating in the recent publication of new treatment guidelines by the American College of Rheumatology. Although newer biologics have been approved and continue to be a focus of research, they have, for the most part, been relatively disappointing compared to the effectiveness of biologics in other autoimmune diseases. Early diagnosis and treatment are essential for renal preservation.
Collapse
Affiliation(s)
- Andrea T Borchers
- Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis School of Medicine, Davis, CA 95616, United States
| | | | | | | | | | | |
Collapse
|
23
|
Hahn BH, McMahon MA, Wilkinson A, Wallace WD, Daikh DI, FitzGerald JD, Karpouzas GA, Merrill JT, Wallace DJ, Yazdany J, Ramsey-Goldman R, Singh K, Khalighi M, Choi SI, Gogia M, Kafaja S, Kamgar M, Lau C, Martin WJ, Parikh S, Peng J, Rastogi A, Chen W, Grossman JM. American College of Rheumatology guidelines for screening, treatment, and management of lupus nephritis. Arthritis Care Res (Hoboken) 2012. [DOI: 10.1002/acr.21664 5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
|
24
|
Hahn BH, McMahon MA, Wilkinson A, Wallace WD, Daikh DI, Fitzgerald JD, Karpouzas GA, Merrill JT, Wallace DJ, Yazdany J, Ramsey-Goldman R, Singh K, Khalighi M, Choi SI, Gogia M, Kafaja S, Kamgar M, Lau C, Martin WJ, Parikh S, Peng J, Rastogi A, Chen W, Grossman JM. American College of Rheumatology guidelines for screening, treatment, and management of lupus nephritis. Arthritis Care Res (Hoboken) 2012; 64:797-808. [PMID: 22556106 PMCID: PMC3437757 DOI: 10.1002/acr.21664] [Citation(s) in RCA: 925] [Impact Index Per Article: 77.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Bevra H Hahn
- School of Medicine, University of California-Los Angeles, CA 90095-1670, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Rivera F, Fulladosa X, Poveda R, Frutos MA, García-Frías P, Ara J, Illescas L, López-Rubio E, Mérida E, Carreño A, Ballarín J, Fernández-Juárez G, Baltar J, Ramos C, Pons S, Oliet A, Vigil A, Praga M, Segarra A. Mycophenolate as induction therapy in lupus nephritis with renal function impairment. Am J Nephrol 2012; 35:424-33. [PMID: 22517244 DOI: 10.1159/000337916] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Accepted: 03/08/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Mycophenolate (MF) is effective as induction therapy for lupus nephritis (LN) in patients with normal renal function; however, little is known about its role in patients with impaired renal failure. The purpose of this study was to evaluate the response to MF in LN and its association with baseline renal function. METHODS Data were obtained for 90 patients from 12 Spanish renal units who were receiving MF as induction therapy for LN. Patients were classified into 2 groups: group 1 (estimated glomerular filtration rate [eGFR] ≥60 ml/min/1.73 m(2)) and group 2 (eGFR <60 ml/min/ 1.73 m(2)). The primary outcome measure was the percentage of patients who achieved any response and its relationship with initial eGFR. The secondary outcome measures were the percentage of patients who achieved a complete response (CR) or partial response (PR) and the appearance of relapses during treatment and side effects. RESULTS At initiation of MF treatment, there were no differences in the main parameters between group 1 (n = 63; eGFR 87 ± 23 ml/min/ 1.73 m(2)) and group 2 (n = 27; eGFR 44 ± 12 ml/min/1.73 m(2)). Exposure to prednisone and MF was similar. The percentages of patients who achieved a response in groups 1 and 2 were, respectively, 69.2 and 43.8% at 6 months and 81.3 and 73.7% at 12 months. CR was more frequent in group 1, whereas PR was similar in both groups. Four patients relapsed and side effects were unremarkable. CONCLUSIONS MF is effective and safe as induction therapy for LN, and response is even achieved in patients with baseline renal impairment.
Collapse
Affiliation(s)
- F Rivera
- Hospital General de Ciudad Real, Ciudad Real, España. friverahdez @ senefro.org
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|