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Sobhy N, Ezzat Y, Gamal SM, Ghoniem SA, Nasr SS, Badran S, Soliman A, Fouad NA. Cumulative pulse methylprednisolone and its relation to disease activity, damage and mortality in systemic lupus erythematosus patients: A post hoc analysis of COMOSLE-EGYPT study. Clin Rheumatol 2024; 43:985-992. [PMID: 38198114 PMCID: PMC10876750 DOI: 10.1007/s10067-023-06858-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/15/2023] [Accepted: 12/21/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVE To investigate the relation between cumulative intravenous methylprednisolone dose and disease activity, damage, and mortality among a group of Egyptian SLE patients. PATIENTS AND METHODS This is a post hoc analysis of a retrospective multicenter COMOSLE study. Cumulative pulse methylprednisolone dose was abstracted from COMOSLE database. Patients with cumulative pulse dose of ≤ 3.0 g (median dose) were compared to those with cumulative dose of > 3.0 g regarding demographic data, Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and The Systemic Lupus International Collaborating Clinics/ACR Damage Index (SLICC) score as well as treatment received. Additionally, at 1.5, 3, 6, and 9 g of cumulative methylprednisolone, patients were compared regarding SLICC score and risk of mortality. RESULTS Patients who received > 3 g of methylprednisolone were statistically significantly younger at disease onset, had longer disease duration, higher SLEDAI score at last visit, and higher SLICC score (p = 003, p = 0.002, p = 0.004 and p = < 0.001, respectively). Additionally, with every gram increase in the cumulative methylprednisolone, there was a significant increase in SLICC score by 0.169 (B = 0.169, CI = 0.122-0.216, p-value = < 0.001) and an increased risk of mortality by 13.5% (hazard ratio (HR) = 1.135, CI = 1.091-1.180, p-value = 0.001). The best cutoff value of methylprednisolone dose at which damage may occur, ranged between 2.75 (with sensitivity of 81.4% and specificity of 33.9%) and 3.25 g (with sensitivity of 48.3% and specificity of 71.5%). CONCLUSION With every gram increase in the cumulative methylprednisolone, there may be increase in damage and mortality, especially in doses exceeding the range of 2.75-3.25 g. Key Points • Treatment of systemic lupus erythematosus should be with the least possible dose of steroids to decrease the risk of damage and mortality. • With every gram increase in the cumulative intravenous methylprednisolone there may be increase in damage and mortality.
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Affiliation(s)
- Nesreen Sobhy
- Rheumatology Department, Cairo University, Cairo, Egypt.
| | - Yasser Ezzat
- Rheumatology Department, Fayoum University, Fayoum, Egypt
| | | | | | - Sarah S Nasr
- Department of Cancer Epidemiology and Biostatistics, National Cancer Institute, Cairo University, Cairo, Egypt
| | | | - Ahmed Soliman
- Department of Dermatology and Venereology, National Research Center Egypt, Cairo, Egypt
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Elaziz MMA, Gamal SM, Fayed A, Abu-Zaid MH, Ghoniem SA, Teleb DA. High- and low-dose cyclophosphamide in Egyptian lupus nephritis patients: a multicenter retrospective analysis. Z Rheumatol 2024; 83:115-123. [PMID: 37582953 PMCID: PMC10879243 DOI: 10.1007/s00393-023-01386-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND Lupus nephritis (LN) is a common serious presentation of systemic lupus erythematosus. Cyclophosphamide (CYC) and mycophenolate mofetil (MMF) are listed as the first-line drugs in induction therapy for LN. OBJECTIVE This study aimed to compare high- and low-dose CYC in a cohort of Egyptian LN patients. PATIENTS AND METHODS The data of 547 patients with class III/IV active LN who received CYC as induction therapy were retrospectively analyzed. Whereas 399 patients received 6‑monthly 0.5-1 g/m2 CYC doses, 148 patients received six biweekly 500 mg CYC doses. Demographic data, laboratory test results, and disease activity index were recorded and compared at presentation and at 6, 12, 18, 24, and 48 months of follow-up. RESULTS After 48 months, the proportion of patients maintaining normal creatinine levels was higher in the group receiving induction therapy with high-dose CYC (67.9%, 60.4%, p = 0.029), and these patients also had higher proteinuria remission at 36 (26.6%, 14.8%, p = 0.014) and 48 months (24.3%, 12.8%, p = 0.006). Comparison of patient outcomes according to both induction and maintenance therapy showed the best results in patients who received high-dose CYC and continued MMF as maintenance therapy. CONCLUSION High- and low-dose CYC are comparable in early phases of treatment. However, after a longer duration of follow-up, high-dose CYC was associated with higher remission rates in the current cohort.
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Affiliation(s)
| | - Sherif M Gamal
- Rheumatology and Rehabilitation Department, Faculty of medicine, Cairo University Hospital, Cairo University, Al Kasr Al Aini, Old Cairo, Cairo Governorate, 4240310, Cairo, Egypt
| | - Ahmed Fayed
- Department of Internal Medicine, Nephrology Unit, Cairo University Hospital, Cairo, Egypt
| | | | - Shada A Ghoniem
- Rheumatology and Rehabilitation Department, Faculty of medicine, Cairo University Hospital, Cairo University, Al Kasr Al Aini, Old Cairo, Cairo Governorate, 4240310, Cairo, Egypt.
| | - Doaa A Teleb
- Rheumatology and Rehabilitation Department, Faculty of medicine, Cairo University Hospital, Cairo University, Al Kasr Al Aini, Old Cairo, Cairo Governorate, 4240310, Cairo, Egypt
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Labib DA, Shaker OG, El Refai RM, Ghoniem SA, Elmazny A. Association betweenmiRNA-146aand Polymorphisms of its Target Gene,IRAK1, Regarding Susceptibility to and Clinical Features of Systemic Lupus Erythematous and Multiple Sclerosis. Lab Med 2018; 50:34-41. [DOI: 10.1093/labmed/lmy033] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Dalia A Labib
- Division of Clinical and Chemical Pathology, Cairo University, Egypt
| | - Olfat G Shaker
- Division of Medical Biochemistry and Molecular Biology, Cairo University, Egypt
| | - Rasha M El Refai
- Division of Rheumatology and Rehabilitation, Cairo University, Egypt
| | - Shada A Ghoniem
- Division of Rheumatology and Rehabilitation, Cairo University, Egypt
| | - Alaa Elmazny
- Department of Neurology, Cairo University, Egypt
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Momtaz M, Fayed A, Wadie M, Gamal SM, Ghoniem SA, Sobhy N, Kamal Elden NM, Hamza WM. Retrospective analysis of nephritis response and renal outcome in a cohort of 928 Egyptian lupus nephritis patients: a university hospital experience. Lupus 2017; 26:1564-1570. [DOI: 10.1177/0961203317716320] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Aim We aim to describe the pattern of response to treatment in a cohort of Egyptian lupus nephritis (LN) patients and to define variable prognostic factors. Methods We retrospectively analyzed records of 928 systemic lupus erythematosus (SLE) patients (898 females, 30 males) with biopsy-confirmed LN seen between 2006 and 2012 at Cairo University hospitals. Results Our study involved 928 SLE patients with a mean age of 26.25 ± 6.487 years, mean LN duration at time of renal biopsy 6.48 ± 4.27 months, mean SLEDAI 28.22 ± 11.7, and mean follow-up duration of 44.14 ± 17.34 months. Induction treatment achieved remission in 683 patients. Remission was achieved in all 32 patients with class II LN, compared to 651/896 (72.7%) patients in classes III, IV, and V. Induction by intravenous (IV) cyclophosphamide achieved response in 435/575 (75.7%) patients, while induction by mycophenolate mofetil (MMF) resulted in response in 216/321 (67.3%) patients ( p = 0.0068). Nephritic flares were least observed when MMF was used for maintenance (30/239 (12.6%) patients), compared to 71/365 patients (19.5%) ( p = 0.0266) when azathioprine (AZA) was used, and 22/79 patients (27.8%) ( p = 0.002) with IV cyclophosphamide. Class IV LN, high chronicity index, presence of crescents, and interstitial fibrosis in biopsies were all associated with chronic kidney disease (CKD) development eventually ( p < 0.001, p = 0.005, p = 0.012, and p = 0.031, respectively). By the end of the study duration, 305 (32.7%) patients had CKD. Logistic regression detected that high baseline serum creatinine, failure to achieve remission, hypertension, and nephritic flare were the main risk factors for poor renal outcome ( p < 0.001, p < 0.001, p = 0.004, and p < 0.001, respectively). The 5 years’ mortality was 69 (7.4%) patients with sepsis being the main cause of death. Conclusion IV cyclophosphamide superseded as induction treatment, while MMF was the best maintenance treatment. High serum creatinine, hypertension, and nephritic flare were the main risk factors for poor renal outcome.
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Affiliation(s)
- M Momtaz
- Department of Internal Medicine, Cairo University Hospital, Cairo, Egypt
| | - A Fayed
- Department of Internal Medicine, Cairo University Hospital, Cairo, Egypt
| | - M Wadie
- Department of Internal Medicine, Cairo University Hospital, Cairo, Egypt
| | - S M Gamal
- Rheumatology and Rehabilitation Department, Cairo University Hospital, Cairo, Egypt
| | - S A Ghoniem
- Rheumatology and Rehabilitation Department, Cairo University Hospital, Cairo, Egypt
| | - N Sobhy
- Rheumatology and Rehabilitation Department, Cairo University Hospital, Cairo, Egypt
| | - N M Kamal Elden
- Public Health Department, Cairo University Hospital, Cairo, Egypt
| | - W M Hamza
- Pathology Department, Cairo University Hospital, Cairo, Egypt
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Abstract
OBJECTIVES The objective of this paper is to describe renal outcomes in a group of Egyptian patients with lupus nephritis and to identify variable prognostic factors. PATIENTS AND METHODS The records of 135 patients (129 females, six males) with biopsy-proven lupus nephritis seen between 1999 and 2011 at Kasr Al-Aini Hospital, Cairo University, were reviewed and included in a retrospective analysis. Biopsies were classified according to the WHO classification. Renal outcomes were defined according to the Renal Subcommittee of Renal Insufficiency of the American College of Rheumatology. RESULTS The mean follow-up period was 55.64 ± 25.68 (range 4-156) months. Thirty-nine patients (29.9%) developed an adverse final outcome. This composite outcome, defined as persistent elevation of serum creatinine ≥ 1.2 mg/dl, chronic renal insufficiency, end-stage renal disease or death, was seen in 12 (8.9%), seven (5.2%), three (2.2%) and 17 (12.6%) patients, respectively. The overall patient survival was 93.5% and 87.5% at five and 10 years, respectively. Factors associated with an adverse outcome included male gender (p = 0.037), hypertension at nephritis onset (p = 0.001), serum creatinine ≥1.2 mg/dl (p < 0.001), urinary casts (p = 0.006), anticardiolipin antibodies (p = 0.03), class IV nephritis (p < 0.001), hyaline thrombosis (0.003), glomerular sclerosis (p = 0.002), tubular atrophy(p < 0.001), interstitial fibrosis (p < 0.001) and a higher chronicity index (p = 0.006). Time-dependent factors associated with an adverse outcome included failure to achieve remission within the first year, uncontrolled hypertension, persistently low C3 and development of flares (p = 0.003, < 0.001, = 0.004, = 0.003, respectively). CONCLUSION The association of several adverse prognostic factors with the development of poor renal outcome has been confirmed in this study.
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Affiliation(s)
- G A Mahmoud
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Cairo University, Egypt
| | - H S Zayed
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Cairo University, Egypt
| | - S A Ghoniem
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Cairo University, Egypt
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