Extended follow-up of the CYCLOFA-LUNE trial comparing two sequential induction and maintenance treatment regimens for proliferative lupus nephritis based either on cyclophosphamide or on cyclosporine A

Závada, Jakub; Pešickova, SS; Ryšavá, R; Horák, Pavel; Hrncír, Z; Lukáč, J; Rovenský, Jozef; Vítová, J; Havrda, Martin; Rychlík, Ivan; Böhmová, J; Vlasáková, Věra; Slatinska, Janka; Zadrazil, J; Olejárova, M.; Tegzová, Dana; Tesař, Vladimı́r

doi:10.1177/0961203313511555

Cited by 32 publications

(13 citation statements)

References 15 publications

(15 reference statements)

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“…Multiple small RCTs showed that lupus nephritis induction with calcineurin inhibitors (cyclosporine or tacrolimus) is as effective as cyclophosphamide or mycophenolate [200–203]. A recent metanalysis suggested a possible superiority of tacrolimus over cyclophosphamide [204].…”

Section: Managementmentioning

confidence: 99%

Systemic lupus erythematosus: Diagnosis and clinical management

Fava

Petri

2019

Journal of Autoimmunity

477

322

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Systemic lupus erythematosus (SLE) is a worldwide chronic autoimmune disease which may affect every organ and tissue. Genetic predisposition, environmental triggers, and the hormonal milieu, interplay in disease development and activity. Clinical manifestations and the pattern of organ involvement are widely heterogenous, reflecting the complex mosaic of disrupted molecular pathways converging into the SLE clinical phenotype. The SLE complex pathogenesis involves multiple cellular components of the innate and immune systems, presence of autoantibodies and immunocomplexes, engagement of the complement system, dysregulation of several cytokines including type I interferons, and disruption of the clearance of nucleic acids after cell death. Use of immunomodulators and immunosuppression has altered the natural course of SLE. In addition, morbidity and mortality in SLE not only derive from direct immune mediated tissue damage but also from SLE and treatment associated complications such as accelerated coronary artery disease and increased infection risk. Here, we review the diagnostic approach as well as the etiopathogenetic rationale and clinical evidence for the management of SLE. This includes 1) lifestyle changes such as avoidance of ultraviolet light; 2) prevention of comorbidities including coronary artery disease, osteoporosis, infections, and drug toxicities; 3) use of immunomodulators (i.e. hydroxychloroquine and vitamin D); and 4) immunosuppressants and targeted therapy. We also review new upcoming agents and regimens currently under study.

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Section: Managementmentioning

confidence: 99%

Systemic lupus erythematosus: Diagnosis and clinical management

Fava

Petri

2019

Journal of Autoimmunity

477

322

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“…Most evidence suggests CyA efficacy in proliferative lupus nephritis, as supported by few case series [66,[73][74][75][76][77][78] and uncontrolled trials [79,80]. In addition, CyA has been shown to be more beneficial than steroids alone [81] and as effective as AZA [82] and cyclophosphamide (CTX), both at short [83] and long term follow-up [84]. As a whole, it can be stated that CyA treatment in proliferative lupus nephritis displays a cumulative rate of complete or partial remission approaching 90%, with an important antiproteinuric effect [85].…”

Section: Cyclosporine a In Systemic Lupus Erythematosusmentioning

confidence: 99%

The Use of Cyclosporine A in Rheumatology: a 2016 Comprehensive Review

Chighizola

Ong

Meroni

2016

Clinic Rev Allerg Immunol

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Cyclosporine A, an inhibitor of calcineurin, exerts an immunomodulator action interfering with T cell activation. Even though novel therapeutic tools have emerged, CyA still represents a suitable option in several clinical rheumatology settings. This is the case of refractory nephritis and cytopenias associated with systemic lupus erythematosus. Furthermore, CyA is a valued therapeutic tool in the management of uveitis and thrombophlebitis in course of Behçet's disease. Topical CyA has been proven to be beneficial in the dry eye of Sjogren's syndrome, whereas oral treatment with CyA can be considered for the severe complications of adult onset Still's disease. CyA provides a therapeutic option in psoriatic arthritis, being rather effective in skin disease. CyA is currently regarded as a second-line option for patients with inflammatory myopathies refractory to standard regimen. CyA is used even in paediatric rheumatology, in particular in the management of juvenile dermatomyositis and macrophage activation syndrome associated with systemic juvenile idiopathic arthritis. Importantly, CyA has been shown to suppress the replication of HCV, and it can thus be safely prescribed to those patients with chronic hepatitis C. Noteworthy, CyA can be administered throughout the gestation course. Surely, caution should be paid to CyA safety profile, in particular to its nephrotoxicity. Even though most evidence comes from small and uncontrolled studies with few randomised controlled trials, CyA should be still regarded as a valid therapeutic tool in 2016 rheumatology.

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“…Cyclosporin A (CYS A) is an immunosuppressant agent widely used in the context of antirejection therapy. In rheumatology, the drug is approved for the treatment of rheumatoid (RA) and psoriatic arthritis (PA), but in clinical practice, it is also daily employed to treat other connective tissue diseases (CTDs) such as systemic lupus erythematosus (SLE), dermatomyositis (DM), and in patients suffering from systemic vasculitis …”

Section: Introductionmentioning

confidence: 99%