Successful Treatment of Class IV+V Lupus Nephritis with Combination Therapy of High-dose Corticosteroids, Tacrolimus and Intravenous Cyclophosphamide

Kurasawa, Takahiko; Nagasawa, Hayato; Nishi, Eiko; Takei, Hiroyuki; Okuyama, Atsushi; Kondo, Tsuneo; Nishimura, Koji; Sakai, Ryota; Shibata, Akiko; Chino, Kentaro; Ogawa, Hidenori; Itô, Tatsuya; Amano, Koichi; Kato, Hitoshi

doi:10.2169/internalmedicine.52.9366

Cited by 6 publications

(5 citation statements)

References 28 publications

(26 reference statements)

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“…Bao et al [19] first reported in 2008 that tacrolimus plus MMF could achieve a higher complete remission rate within 24 weeks than CYC (50% vs. 5%, p < .05) [19] in the treatment of mixed diffuse proliferative and membranous LN (class III or IV þ V). Recently, we reported a prospective, open-label, single-center, pilot study of a multi-target therapy comprising CYC and tacrolimus [20]. In this study prednisolone (PSL) was started at a dose of 0.6-1.0 mg/kg/ day for 2 weeks and 500 mg of intravenous CYC was administered biweekly for 3 months (six times) with 3 mg/day of tacrolimus daily.…”

Section: Systemic Lupus Erythematosusmentioning

confidence: 99%

Era of steroid sparing in the management of immune-mediated inflammatory diseases

Kondo

Amano

2018

Immunological Medicine

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Glucocorticoids (GCs) have played a pivotal role in the treatment of immune-mediated inflammatory diseases (IMIDs) for a long time. However, GCs also incur a significant risk of undesirable adverse events such as Cushingoid changes, osteoporosis, glaucoma and metabolic abnormalities such as diabetes and hypercholesterolemia, which may lead to lifethreatening cerebrovascular and cardiovascular events. High-dose GCs may also cause mental disorders and osteonecrosis. Recently, new therapeutic strategies have been developed to reduce the dose or even eliminate the need for GCs; multi-target drug therapies for systemic lupus erythematosus (SLE), biological agents such as tocilizumab and rituximab for systemic vasculitis, and anakinra and tocilizumab for adult-onset still's disease. Therefore, the era of GC-sparing or GC-free treatment for IMIDs is on the horizon.

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Section: Systemic Lupus Erythematosusmentioning

confidence: 99%

Era of steroid sparing in the management of immune-mediated inflammatory diseases

Kondo

Amano

2018

Immunological Medicine

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“…Frequently relapsing nephrotic syndrome refers to at least two relapses during treatment within six months or more than three relapses within 12 months of the initial presentation. 1,2 It is a common nephropathic disease. It has different pathological types.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of leflunomide combined with prednisone in the treatment of refractory nephrotic syndrome

Liu

Chen

et al. 2016

Renal Failure

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Objective: To assess the safety and clinical efficacy of leflunomide (LEF) and prednisone on refractory nephrotic syndrome (RNS). Methods: A total of 52 patients with RNS were treated for 24 weeks between 2010 and 2014 in our hospital. In the treated group, 26 patients were treated with LEF and prednisone, and, in the control group, 26 patients were treated with cyclophosphamide (CTX) and prednisone. During the treatment, 24 h urinary protein excretion and the serum levels of albumin and cholesterol, and kidney function were assayed before and after the therapy. Adverse reactions during treatment were recorded. Results: In the LEF group, the medication was markedly effective in eight cases and effective in nine cases; the total efficacy rate was 65.30%. In the CTX group, the treatment was markedly effective in six cases and effective in nine cases; the total efficacy rate was 57%. There were no significant differences between the results of the total efficacy rate (p > .05). The 24 h urinary protein excretion and serum cholesterol levels in both groups decreased after therapy and the serum levels of albumin in both groups increased after therapy. There were significant differences between the results for the 24 h urinary protein excretion, serum levels of albumin and cholesterol in the two groups (p < .05). The treatments were well tolerated in both groups. Conclusion: LEF combined with prednisone has a certain efficacy on the RNS and displays few adverse reactions. A large-sample, randomized double-blind controlled study and long-term follow-up are needed to verify the efficacy of LEF combined with prednisone. ARTICLE HISTORY

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“…Previous studies have reported successful treatment of LN patients who did not respond to IV-CYC by adding TAC. 32 Sakai's study showed that the combination of TAC (3.0 mg/day) and CYC resulted in a signi cantly higher CR rate after 6 months compared to CYC alone. 33 Our study provides a clearer separation of TAC doses compared with previous studies and con rms the multiplicative interaction between different doses of TAC and CYC.…”

Section: Discussionmentioning

confidence: 99%

The effect of tacrolimus combined with mycophenolate mofetil or cyclophosphamide on renal response in systemic lupus erythematosus patients

Sun,

Zhang,

Guo

et al. 2024

Preprint

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Objective This study aimed to determine the therapeutic effect of tacrolimus (TAC) and its combination with mycophenolate mofetil (MMF) or cyclophosphamide (CYC) on the complete response (CR) in patients with systemic lupus erythematosus (SLE). Methods A retrospective cohort study based on medical data was conducted among SLE patients taking at least one of TAC, MMF and CYC during 2010–2021. Odds ratio (OR) and 95% confidence interval (CI) were calculated and multiplicative interactions were estimated using logistic regression models. Results Among 793 SLE patients, 27.9% (221 cases) patients achieved CR after at least 3 months. TAC use was positively associated with CR with adjusted OR (95% CI) of 2.82(1.89, 4.22) in overall, as well as in subgroups of SLE patients with SLEDAI score > 12, moderate or severe urinary protein and comorbidities. The dose-response effect on CR was further observed at the dose of TAC more than 4 mg/d and more than 180 days, with adjusted OR (95% CI) of 5.65(2.35, 13.55), and 3.60(2.02, 6.41) respectively. Moreover, the combined effect of TAC with MMF or CYC was better than monotherapy with the significant multiplicative interaction, with adjusted OR (95% CI) of 2.43(1.20,4.92) and 3.14(1.49,6.64), respectively, and similar results were also observed for the combination of different doses of TAC with MMF or CYC. Conclusion TAC can effectively alleviate the condition of patients with SLE and may interact with MMF or CYC, suggesting that the combination therapy of TAC with MMF or CYC may produce greater benefits for patients with SLE. Trial registration: This is a purely observational study that does not require registration.

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Successful Treatment of Class IV+V Lupus Nephritis with Combination Therapy of High-dose Corticosteroids, Tacrolimus and Intravenous Cyclophosphamide

Cited by 6 publications

References 28 publications

Era of steroid sparing in the management of immune-mediated inflammatory diseases

Era of steroid sparing in the management of immune-mediated inflammatory diseases

Efficacy of leflunomide combined with prednisone in the treatment of refractory nephrotic syndrome

The effect of tacrolimus combined with mycophenolate mofetil or cyclophosphamide on renal response in systemic lupus erythematosus patients

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