Objectives To characterize a LN cohort over 40 years, assessing its evolution, analysing two major outcomes: the development of end-stage renal disease and mortality rates in the first 5 years after LN diagnosis. Methods An observational retrospective study of patients with LN, followed up from 1975 at University College Hospital. Patients were divided into four groups, depending on the decade of LN diagnosis: 1975–1985 (D1), 1986–1995 (D2), 1996–2005 (D3) and 2006–2015 (D4). Comparison between groups was performed with respect to demographic, clinical, serological and histological characteristics and outcome. Results Two hundred and nineteen patients with LN were studied. There was a change in ethnic distribution, with a decreasing proportion of Caucasians (58.6% in D1 to 31.3% in D4, P = 0.018) and increase in African-ancestry (17.2% in D1 to 39.6% in D4, P = 0.040). Serological and histological patterns changed throughout time, with a reduction in class IV nephritis (51.7% in D1 to 27.1% in D4, P = 0.035), and increase in class II nephritis (10% in D2 to 18.8% in D4, P = 0.01) and anti-extractable nuclear antigen antibody positivity (17.2% in D1 to 83.3% in D4, P = 0.0001). The 5-year mortality rates decreased from D1 (24.1%) to D2 (4%), stabilizing for the next 30 years. The 5-year progression to end-stage renal disease remained stable over the decades. Conclusion Despite the changes in treatment of LN in the past 20 years, we have reached a plateau in 5-year mortality and progression to end-stage renal disease rates, suggesting that new therapeutic and management approaches, and strategies to enhance adherence, are needed to improve outcomes further in LN patients.
Introduction A patent foramen ovale (PFO) is often diagnosed in cryptogenic strokes and concurrent pulmonary embolism (PE) may be associated. Although often asymptomatic and with low recurrence risk, the best therapy is controversial. Purpose To study the results of oral anticogulation (OAC) in this population. Methods Retrospective single-centre study (2015–2020) of pts with asymptomatic PE diagnosed after a paradoxical stroke due to a PFO. Results Forty pts were included. Mean age was 56 ± 11 years and 55% were female. At diagnosis, 27.5%, 50.0%, 17.5% and 5.9% had none, weak, moderate and strong predisposing factors for PE, respectively. Most pts had peripheral events: 60.0% subsegmental, 37.5% segmental and 2.5% lobar. Regarding treatment, 97.5% initiated OAC (90.0% direct OAC, 7.5% vitamin K antagonist); 1 pt single antiaggregation; 30% had percutaneous PFO closure. Mean clinical follow-up (FUP) was 32 ± 22 months. There was 1 recurrent PE and 1 non-cardiovascular death. Mean time under OAC (TUOAC) was 27 ± 26 months. The only predictor of OAC suspension was PFO closure (17.9% vs. 50.0%, P = 0.037). Of these pts, 50.0% suspended OAC after the procedure (TUOAC 23.2 ± 17.9 months); the remaining had a TUOAC of 28.9 ± 29.9 months. Age or PE predisposing factors were not associated with OAC suspension or TUOAC. There were 3 clinically relevant haemorrhagic events (1 BARC3a,1 BARC3b, 1 BARC3c). TUOAC was neither associated with bleeding (P = 0.307) nor with perfusion defects resolution in FUP scintigraphy (55.5 vs. 16.0 months, P = 0.172). Conclusions TUOAC was not associated with perfusion defects resolution, ischemic or bleeding events. Management of these pts needs more evidence and consensus.
Objective To identify clinical and serological features that distinguish patients with systemic lupus erythematosus (SLE) who require single as opposed to repeated rituximab (RTX) cycles. Methods All 175 SLE patients followed-up at University College hospital from 2000 onwards were retrospectively reviewed. They were divided into a one RTX cycle and multiple-cycle groups (2 or more). Patients included had a follow-up of at least 3 years after their first RTX cycle, unless they needed a second infusion sooner. Results 131 patients were included; 44 (33.6%) received one cycle of RTX and 87 (66.4%) received two or more. The former were older at diagnosis (31.4 vs 21 years, p< 0.001) and at first RTX infusion (39.9 vs 29 years, p< 0.001). This group of patients had more organs/systems involved (p= 0.044), more leukopenia, lymphopenia and thrombocytopenia (p= 0.001, <0.0001 and 0.003 respectively) and lower C3 levels (p= 0.035). They also had fewer immunosuppressive (IS) drugs before RTX therapy compared with those who required multiple RTX cycles (p= 0.003). There was no statistical difference in the clinical and serological response after the first RTX cycle between both groups. Furthermore, patients who had received more IS treatments were more likely to require more than one cycle of RTX infusions (p= 0.007). Conclusions RTX is an effective option for SLE patients with severe flares. Patients who received more immunosuppressive drugs are more likely to receive more than one set of RTX infusions. This suggests that RTX is best used for SLE patients with no history of refractory disease.
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