Fatal infection in children with lupus nephritis treated with intravenous cyclophosphamide

Laoprasopwattana, Kamolwish; Dissaneewate, Pornsak; Vachvanichsanong, Prayong

doi:10.1007/s00467-009-1152-7

Cited by 9 publications

(6 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In our study, more than one‐third of the children with serious infections had 3 or more such episodes, which is higher than what was reported in prior series . A study of children treated with cyclophosphamide for LN in Thailand reported that fatal infections occurred in 13 of 84 patients (15%) . The authors observed that previous treatment with pulse methylprednisolone, kidney disease, and fungal infection were associated with fatal infections in their population.…”

Section: Discussioncontrasting

confidence: 63%

Serious Infection Rates Among Children With Systemic Lupus Erythematosus Enrolled in Medicaid

Hiraki

Feldman

Marty

et al. 2017

Arthritis Care & Research

View full text Add to dashboard Cite

Objective To investigate the nationwide prevalence and incidence of serious infections among children with systemic lupus erythematosus (SLE) enrolled in Medicaid, the U.S. health insurance program for low-income patients. Methods From Medicaid claims (2000–2006) we identified children 5 to <18 years old with SLE (≥3 ICD-9 codes of 710.0, each >30 days apart) and lupus nephritis (LN; ≥2 ICD-9 codes for kidney disease on/after SLE codes). From hospital discharge diagnoses, we identified infection subtypes (bacterial, fungal, viral). We calculated incidence rates (IR) per 100 person-years (PY), mortality rates, and hazard ratios adjusted for sociodemographic factors, medications, and preventive care. Results Among 3,500 children with SLE identified, 1,053 serious infections occurred over 10,108 person-years; the IR was 10.42/100 PY (95% CI 9.80, 11.07) among all those with SLE and 17.65/100 PY (95% CI 16.29, 19.09) among those with LN. Bacterial infections were most common (87%; of which 39% were bacterial pneumonias). In adjusted models, African Americans and Native Americans had higher rates of infections compared with white children, and those with comorbidities or receiving corticosteroids had higher infection rates than those without. Males had lower rates of serious infections compared to females. The 30-day post-discharge mortality rate was 4.4%. Conclusions Overall, hospitalized infections were very common in children with SLE, with bacterial pneumonia being the most common infection. Highest infection risks were among African and Native American children, those with LN, comorbidities, and those taking corticosteroids.

show abstract

Section: Discussioncontrasting

confidence: 63%

Serious Infection Rates Among Children With Systemic Lupus Erythematosus Enrolled in Medicaid

Hiraki

Feldman

Marty

et al. 2017

Arthritis Care & Research

View full text Add to dashboard Cite

show abstract

“…We have previously reported finding 64 infection complications in 32 out of 84 SLE patients whose condition indicated treatment with intravenous cyclophosphamide (IVCY), a figure which is higher than in other studies 20 21…”

Section: Discussionmentioning

confidence: 76%

Twenty-two years' experience with childhood-onset SLE in a developing country: are outcomes similar to developed countries?

Vachvanichsanong

Dissaneewate

McNeil

2010

Archives of Disease in Childhood

View full text Add to dashboard Cite

IntroductionThe outcome of systemic lupus erythematosus (SLE) has dramatically improved since the introduction of corticosteroids; however, although many regimens of treatment have been supplemented, the mortality has not improved further. Objective To describe the severity and outcome in patients diagnosed with SLE aged ≤18 years in a group of Thai children, compare gender and age differences, and our outcomes with those from developed countries. Methods The authors retrospectively reviewed the fi les of patients aged ≤18 years diagnosed with SLE admitted to Songklanagarind University Hospital in southern Thailand, for the period 1985-2007. Patient survival rates were calculated. Results There were 213 SLE patients, 41 males and 172 females, average age 11.6±2.6 years, with a median follow-up of 3.6 years. Outcomes were alive (109), lost to follow-up (22), referred (31) or deceased (51). Of the patients who were alive, 23 were not on any treatment, 59 were on prednisolone alone while 27 were on prednisolone plus some other immunosuppressive drug. Total survival rates were 88%, 76% and 64% at 2, 5 and 10 years, respectively. Males had signifi cantly worse survival than females at 2 and 5 years (78% vs 91% and 58% vs 80%, respectively, p=0.018). There were no differences in mortality between age groups. The 5-year survival rates in the periods 1985-1993, 1994-2000 and 2001-2007 were not signifi cantly different. Conclusion This retrospective study of patients with SLE in southern Thailand showed different outcomes compared to some studies and similar survival rates and treatment status to other studies, with one-fourth of surviving patients being free of medication.

show abstract

“…Infection is a common complication in SLE patients treated with IVCY therapy, as we previously reported, with opportunistic infections being the most common [ 21 ]. Severe infections were found in 36.9 % (31/84) of those cases, of whom 13 died (41.9 %).…”

Section: Discussionmentioning

confidence: 97%

Intravenous cyclophosphamide combined with steroids in pediatric onset severe lupus nephritis

2012

Self Cite

View full text Add to dashboard Cite

BackgroundIntravenous cyclophosphamide (IVCY) has been used to treat severe lupus nephritis (LN) for many years. Because of the wide variety of manifestations of the condition and the long-term nature of the disease, outcomes vary widely.ObjectiveTo evaluate and compare the immediate and long-term results of IVCY in pediatric onset severe LN and between patients with normal and abnormal initial renal function.MethodsPatients aged <18 years who attended the Department of Pediatrics, Prince of Songkla University, diagnosed with severe LN, and who were given a 36-month IVCY course, were included. Comparison of overall survival between the two groups was assessed using Kaplan–Meier survival curves.Results108 patients with a mean age of 12.6 ± 2.7 years were studied, with a mean follow-up time of 5.7 ± 4.3 years. 48 patients completed the IVCY course. 36 patients had abnormal renal function and 72 patients had normal renal function at the start of therapy. Both groups responded well initially to treatment; proteinuria reduced to normal levels after 1 and 2 treatments in the normal and abnormal groups, respectively, while creatinine clearance returned to normal levels after 8 treatments in the abnormal group. Overall survival was not different between the two groups; however, the abnormal renal function group had a higher crude mortality rate than the normal group (13/36 vs 10/72, p value = 0.02). At the time of analysis, some patients who had completed their IVCY course still required other therapy to control their disease activity.ConclusionThree years of IVCY treatment provided similar outcomes in both normal and abnormal renal function groups. Immediate outcomes were favorable but long-term remission was not promising.

show abstract

Fatal infection in children with lupus nephritis treated with intravenous cyclophosphamide

Cited by 9 publications

References 35 publications

Serious Infection Rates Among Children With Systemic Lupus Erythematosus Enrolled in Medicaid

Serious Infection Rates Among Children With Systemic Lupus Erythematosus Enrolled in Medicaid

Twenty-two years' experience with childhood-onset SLE in a developing country: are outcomes similar to developed countries?

Intravenous cyclophosphamide combined with steroids in pediatric onset severe lupus nephritis

Contact Info

Product

Resources

About