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Zhang L, Cui JY, Zhang L. Clinical efficacy and safety of sirolimus in childhood-onset systemic lupus erythematosus in real world. Medicine (Baltimore) 2022; 101:e31551. [PMID: 36401486 PMCID: PMC9678567 DOI: 10.1097/md.0000000000031551] [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] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
To investigate the effectiveness and safety of sirolimus in childhood-onset systemic lupus erythematosus in a real world. This is a retrospective real world clinical study. All childhood-onset systemic lupus erythematosus patients treated with sirolimus in Children's Hospital of Hebei Province China were analyzed. They were treated with sirolimus and followed up regularly. The patients had systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) score, levels of antidouble-stranded DNA antibody, complement components C3 and C4, 24-hour proteinuria and corticosteroid reduction were recorded at baseline and at 6, 12, and 18 months. Adverse events were also collected. Thirty-two patients were enrolled in the study. SLEDAI-2K were improved on all time-points (P < .05). Complement levels increased and the levels of antidouble-stranded DNA antibody decreased during treatment. The mean dose of prednisone tapered and achieved significant reduction after 12 months therapy (15.4 ± 5.8 mg/d to 4.8 ± 2.1 mg/d; P < .05). Sirolimus was well tolerated and only 5 patients (15.6%) experienced adverse events, all of which were classified as infections (2 bacterial infection and 3 viral infections). No deaths, severe infusion reactions, or hypersensitivity reactions were found. Sirolimus use was associated with a decrease in disease activity and ability to tolerate tapering of oral glucocorticoid dose with a favorable risk-benefit profile.
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Affiliation(s)
- Lei Zhang
- Department of Pediatric, The Third Hospital of Hebei Medical University, Shijiazhuang, China
- Department of Nephrology and Immunology, Children’s Hospital of Hebei Province, Shijiazhuang, China
| | - Jie-Yuan Cui
- Department of Nephrology and Immunology, Children’s Hospital of Hebei Province, Shijiazhuang, China
| | - Lin Zhang
- Department of Nephrology and Immunology, Children’s Hospital of Hebei Province, Shijiazhuang, China
- *Correspondence: Lin Zhang, Department of Nephrology and Immunology, Children’s Hospital of Hebei Province, Shijiazhuang 050031, China (e-mail: )
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Brunner HI, Holland MJ, Beresford MW, Ardoin SP, Appenzeller S, Silva CA, Flores F, Goilav B, Aydin POA, Wenderfer SE, Levy DM, Ravelli A, Khubchandani R, Avcin T, Klein-Gitelman MS, Ruperto N, Feldman BM, Ying J. American College of Rheumatology Provisional Criteria for Clinically Relevant Improvement in Children and Adolescents With Childhood-Onset Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2019; 71:579-590. [PMID: 30680946 PMCID: PMC6483875 DOI: 10.1002/acr.23834] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 01/08/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To develop a Childhood Lupus Improvement Index (CHILI) as a tool to measure response to therapy in childhood-onset systemic lupus erythematosus (cSLE), with a focus on clinically relevant improvement (CRIc SLE ). METHODS Pediatric nephrology and rheumatology subspecialists (n = 213) experienced in cSLE management were invited to define CRIc SLE and rate a total of 433 unique patient profiles for the presence/absence of CRIc SLE . Patient profiles included the following cSLE core response variables (CRVs): global assessment of patient well-being (patient-global), physician assessment of cSLE activity (MD-global), disease activity index score (here, we used the Systemic Lupus Erythematosus Disease Activity Index), urine protein-to-creatinine ratio, and Child Health Questionnaire physical summary score. Percentage and absolute changes in these cSLE-CRVs (baseline versus follow-up) were considered in order to develop candidate algorithms and validate their performance (sensitivity, specificity, area under the receiver operating characteristic curve [AUC]; range 0-1). RESULTS During an international consensus conference, unanimous agreement on a definition of CRIc SLE was achieved; cSLE experts (n = 13) concurred (100%) that the preferred CHILI algorithm considers absolute changes in the cSLE-CRVs. After transformation to a range of 0-100, a CHILI score of ≥54 had outstanding accuracy for identifying CRIc SLE (AUC 0.93, sensitivity 81.1%, and specificity 84.2%). CHILI scores also reflect minor, moderate, and major improvement for values exceeding 15, 68, and 92, respectively (all AUC ≥0.92, sensitivity ≥93.1%, and specificity ≥73.4%). CONCLUSION The CHILI is a new, seemingly highly accurate index for measuring CRI in cSLE over time. This index is useful to categorize the degree of response to therapy in children and adolescents with cSLE.
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Affiliation(s)
- Hermine I. Brunner
- Department of Pediatrics, University of Cincinnati College of Medicine and Division of Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Michael J. Holland
- Department of Pediatrics, University of Cincinnati College of Medicine and Division of Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Michael W. Beresford
- Department of Paediatric Rheumatology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK; Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | - Stacy P. Ardoin
- Department of Pediatrics and Internal Medicine, Ohio State University, Division of Rheumatology, Nationwide Children’s Hospital and Wexner Medical Center, Columbus, OH
| | - Simone Appenzeller
- Rheumatology Unit-School of Medical Science; University of Campinas, Campinas, Brazil
| | - Clovis A. Silva
- Children’s Institute, Hospital das Clinicas HCFMUSP; Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Francisco Flores
- Department of Pediatrics, University of Cincinnati College of Medicine and Division of Nephrology & Hypertension, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Beatrice Goilav
- Department of Pediatrics, The Children’s Hospital at Montefiore, Division of Nephrology and Albert Einstein College of Medicine, Bronx, NY
| | - Pinar Ozge Avar Aydin
- Department of Pediatrics, University of Cincinnati College of Medicine and Division of Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Scott E. Wenderfer
- Department of Pediatrics, Baylor College of Medicine; Renal Section, Texas Children’s Hospital Houston, TX
| | - Deborah M. Levy
- Department of Pediatrics, University of Toronto and Division of Rheumatology, The Hospital for Sick Children, Toronto, Canada
| | - Angelo Ravelli
- Istituto G. Gaslini, Clinica Pediatrica e Reumatologia, PRINTO, Genoa, Italy
| | | | - Tadej Avcin
- Department of Allergology, Rheumatology and Clinical Immunology, University Children’s Hospital, University Medical Centre Ljubljana, Slovenia
| | - Marisa S. Klein-Gitelman
- Department of Pediatrics, Northwestern University Feinberg School of Medicine and Division of Rheumatology, Ann and Robert Lurie Children’s Hospital of Chicago, Chicago, IL
| | - Nicolino Ruperto
- Istituto G. Gaslini, Clinica Pediatrica e Reumatologia, PRINTO, Genoa, Italy
| | - Brian M. Feldman
- Department of Pediatrics, University of Toronto and Division of Rheumatology, The Hospital for Sick Children, Toronto, Canada
| | - Jun Ying
- Department of Environmental Health Sciences, University of Cincinnati, Cincinnati, OH
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AlE'ed A, Aydin POA, Al Mutairi N, AlSaleem A, Sonmez HE, Henrickson M, Huggins JL, Ozen S, Al-Mayouf SM, Brunner HI. Validation of the Cutaneous Lupus Erythematosus Disease Area and Severity Index and pSkindex27 for use in childhood-onset systemic lupus erythematosus. Lupus Sci Med 2018; 5:e000275. [PMID: 30538816 PMCID: PMC6257379 DOI: 10.1136/lupus-2018-000275] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 09/27/2018] [Accepted: 09/27/2018] [Indexed: 11/13/2022]
Abstract
Objective To determine the measurement properties of the Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) and the paediatric adaptation of the Skindex29 (pSkindex27) when used in childhood-onset SLE (cSLE). Methods Patients with mucocutaneous involvement of cSLE were evaluated at the study entry and 6 months later. Besides the CLASI and pSkindex27, the Pediatric Quality of Life Inventory Generic Core scale (PedsQL-GC), its Rheumatology Module (PedsQL-RM), the SLE Disease Activity Index (SLEDAI) and the SLE Damage Index (SDI) were completed. Results The CLASI and pSkindex27 had high internal consistency (both Cronbach α >0.82). Children were able to complete the pSkindex27, with self-report and caregiver proxy-reports showing excellent agreement (intraclass correlation coefficient=0.97). The CLASI Activity Score (CLASI-A) was strongly correlated with the mucocutaneous domain score of the SLEDAI as was the CLASI Damage Score (CLASI-D) with that of the SDI (both: Spearman correlation coefficients (rs) >0.68). pSkindex27 summary scores were moderately correlated with those of the PedsQL-GC and PedsQL-RM (all: rs>|0.51|), the CLASI-A and CLASI-D (both: rs> 0.64), respectively. Patients who experienced a >50% improvement of the CLASI-A between study visits had significantly higher PedsQL-GC and pSkindex27 scores than those without improvement of mucocutaneous features. Conclusion Both CLASI and pSkindex27 are useful assessment tools in cSLE, active and chronic mucocutaneous lesions and their changes over time can be measured using the CLASI and the pSkindex27 can capture the impact of mucocutaneous involvement on patient health-related quality of life.
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Affiliation(s)
- Ashwaq AlE'ed
- Department of Pediatrics, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Pinar Ozge Avar Aydin
- Department of Pediatrics, University of Cincinnati College of Medicine, Division of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Nora Al Mutairi
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Alhanouf AlSaleem
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Hafize Emine Sonmez
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Michael Henrickson
- Department of Pediatrics, University of Cincinnati College of Medicine, Division of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jennifer L Huggins
- Department of Pediatrics, University of Cincinnati College of Medicine, Division of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Seza Ozen
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | | | - Hermine I Brunner
- Department of Pediatrics, University of Cincinnati College of Medicine, Division of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
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Abstract
Childhood-onset systemic lupus erythematosus (cSLE) is a systemic autoimmune disease characterized by the presence of autoantibodies. cSLE often affects multiple organs in the body and is known to have a poorer prognosis than adult-onset disease (Azevedo et al. 2014). Current laboratory tests are clearly insufficient for identifying and monitoring the disease. Recent studies have yielded novel biomarkers for cSLE which can be used for monitoring disease activity and response to treatment. The most encouraging biomarkers will be discussed herein and include cell-bound complement activation products, some genomic profiles, and urinary proteins such as neutrophil gelatinase-associated lipocalin, monocyte chemoattractant protein-1, and others. Previous studies suggested that a combination of the novel biomarkers might help to enhance sensitivity and specificity for early diagnosis, disease monitoring, and prediction of cSLE flares.
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Affiliation(s)
- Khalid M. Abulaban
- Division of Pediatric Rheumatology, Cincinnati Children’s Hospital, Medical Center, MLC 4010, 3333 Burnet Avenue, Cincinnati, OH 45229-3026, USA
| | - Hermine I. Brunner
- Division of Pediatric Rheumatology, Cincinnati Children’s Hospital, Medical Center, MLC 4010, 3333 Burnet Avenue, Cincinnati, OH 45229-3026, USA
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Brunner HI, Klein-Gitelman MS, Higgins GC, Lapidus SK, Levy DM, Eberhard A, Singer N, Olson JC, Onel K, Punaro M, Schanberg L, von Scheven E, Ying J, Giannini EH. Toward the development of criteria for global flares in juvenile systemic lupus erythematosus. Arthritis Care Res (Hoboken) 2010; 62:811-20. [PMID: 20535792 PMCID: PMC3049164 DOI: 10.1002/acr.20126] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [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] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To develop a definition of global flare in juvenile systemic lupus erythematosus (SLE) and derive candidate criteria for measuring juvenile SLE flares. METHODS Pediatric rheumatologists answered 2 Delphi questionnaires to achieve consensus on a common definition of juvenile SLE flare and identify variables for use in candidate flare criteria. The diagnostic accuracy of these candidate flare criteria was tested with data from juvenile SLE patients (n = 98; 623 visits total). Physician-rated change in the juvenile SLE course (worsening, yes/no) between visits served as the criterion standard. RESULTS There was 96% consensus that a "a flare is a measurable worsening of juvenile SLE disease activity in at least one organ system, involving new or worse signs of disease that may be accompanied by new or worse SLE symptoms. Depending on the severity of the flare, more intensive therapy may be required." Variables suggested for use in flare criteria were: physician-rated disease activity (V1), patient well-being, protein:creatinine ratio, a validated disease activity index (V2), the Child Health Questionnaire physical summary score (V3), anti-double-stranded DNA antibodies, erythrocyte sedimentation rate, and complement levels. Using multiple logistic regression, several candidate flare criteria were derived with area under the receiver operating characteristic curve (AUC) as high as 0.92 (sensitivity >or=85%, specificity >or=85%); classification and regression tree analysis suggested that V1, V2, and V3 suffice to identify juvenile SLE flares (AUC 0.81; sensitivity = 64%, specificity = 86%). CONCLUSION Consensus about a definition of global disease flare for juvenile SLE has been obtained and promising candidate flare criteria have been developed. These will need further assessment of their ease of use and accuracy in prospective study.
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Affiliation(s)
- Hermine I Brunner
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229-3039, USA.
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