Discontinuation of therapy in diffuse proliferative lupus nephritis

Ponticelli, Claudio; Moroni, Gabriella; Banfi, G.

doi:10.1016/0002-9343(88)90562-1

Cited by 10 publications

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“…A greater experience can be found in LN, where GC withdrawal seems to be more common; the first successful experience of GC withdrawal in LN was reported by Ponticelli et al in 198836; thereafter, the same group confirmed the results in a larger study with long-term follow-up where 32% of patients were able to completely withdraw GCs and immunosuppressive drugs. Interestingly, Moroni et al did not find significant differences in the clinical presentation, histological characteristics or the type of induction therapy between patients who were able to stop treatment and those who were not, with the exception of a higher activity index in the latter 16…”

Section: Discussionmentioning

confidence: 86%

Glucocorticoid withdrawal in systemic lupus erythematosus: are remission and low disease activity reliable starting points for stopping treatment? A real-life experience

et al. 2019

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ObjectivesTo evaluate the proportion of patients who have successfully withdrawn glucocorticoids (GCs) in a longitudinal cohort of patients with systemic lupus erythematosus (SLE) over a period of 6 years; to evaluate patient characteristics during GC withdrawal in relation to existing definitions of remission and Lupus Low Disease Activity State (LLDAS); and to evaluate the occurrence of flares after GC withdrawal.MethodsPatients who attempted GC withdrawal were identified for the cohort, and the following information was assessed during withdrawal attempts: date of last disease flare, disease activity and damage and ongoing treatment. Information regarding the occurrence of disease flares after GC withdrawal was also recorded for patients who successfully stopped treatment.Definitions of remission were applied to GC withdrawal in line with European consensus criteria (Definitions of remission in SLE [DORIS]) and LLDAS in line with the Asian Pacific Lupus Consortium definition.Results148 patients were involved in the study; GC withdrawal was attempted in 91 patients (61.5%) with 77 patients (84.6%) successfully stopping GCs. At the beginning of the GC reduction, the majority of patients were in complete or clinical remission (48.9% and 39.6%, respectively). Disease activity was significantly lower in patients who successfully stopped GCs, and the proportion of patients in complete remission was higher (54.2%) with respect to patients who failed in their attempt. Among patients who stopped GCs, 18 flares were recorded after a median of 1 year. The time period since the last flare was shorter in patients who experienced flares with respect to patients who did not flare (mean 0.93 years vs 6.0, p<0.001).ConclusionsGC withdrawal is an achievable goal in SLE and may be attempted after a long-term remission or LLDAS to protect the patient from disease flares.

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Section: Discussionmentioning

confidence: 86%

Glucocorticoid withdrawal in systemic lupus erythematosus: are remission and low disease activity reliable starting points for stopping treatment? A real-life experience

et al. 2019

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“…EC: 2+. -En pacientes en remisión prolongada y sin factores de riesgo de recidiva (tabla 1), parece justificado plantearse la retirada del tratamiento de mantenimiento 21,28 . EC: 2+.…”

Section: Figura 1 -Algoritmo Terapéutico De Las Nefritis Lúpicas Tipounclassified

“…EC: 4. -Antes de plantear la retirada del tratamiento, parece justificado completar un mínimo de 12 meses de quiescencia 21,28,30 . EC: 2+.…”

Section: Figura 1 -Algoritmo Terapéutico De Las Nefritis Lúpicas Tipounclassified

Recomendaciones y sugerencias a 4 preguntas clave en nefropatía lúpica: Extracto de la guía de práctica clínica 2015

et al. 2016

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“…In modern schemes of SLE treatment glucocorticoids are usually combined with various other preparations: cyclophosphamide, mycophenolate mofettil, rituximab, cyclosporine, azathioprine, etc. (Ntali et al, 2009;Ponticelli et al, 2010). In addition to their specific effects, all these preparations are given, in particular, in order to lower the dose of steroids, however, up to now glucocorticoids remain the cornerstone in the schemes of SLE treatment.…”

Section: Approaches To Treatment Of Systemic Lupus Erythematosusmentioning

confidence: 99%

Tyrosine-Based Monitoring of Glucocorticoid Therapy of Systemic Lupus Erythematosus

Rass¹

2012

Systemic Lupus Erythematosus

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Discontinuation of therapy in diffuse proliferative lupus nephritis

Cited by 10 publications

References 0 publications

Glucocorticoid withdrawal in systemic lupus erythematosus: are remission and low disease activity reliable starting points for stopping treatment? A real-life experience

Glucocorticoid withdrawal in systemic lupus erythematosus: are remission and low disease activity reliable starting points for stopping treatment? A real-life experience

Recomendaciones y sugerencias a 4 preguntas clave en nefropatía lúpica: Extracto de la guía de práctica clínica 2015

Tyrosine-Based Monitoring of Glucocorticoid Therapy of Systemic Lupus Erythematosus

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