Relapses of lupus nephritis: incidence, risk factors, serology and impact on outcome

Hachmi, Mohamed El; Jadoul, Michel; Lefèbvre, Chantal; Depresseux, Geneviève; Houssiau, Frédéric

doi:10.1191/0961203303lu444oa

Cited by 88 publications

(65 citation statements)

References 19 publications

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“…The choice of 9 mo may be too short a period for the full expression of the benefits, and this may thus bias the study to show benefits for a regimen that has a somewhat more rapid onset of action. Moreover, as studies have shown, 32,33 relapses of LN may be common after the induction treatment. A prolonged follow-up period is needed for the exploration of this treatment's impact on long-term prognosis and the recurrence rate during the maintenance therapy period.…”

Section: Discussionmentioning

confidence: 99%

Successful Treatment of Class V+IV Lupus Nephritis with Multitarget Therapy

Bao

Liu

Xie

et al. 2008

Journal of the American Society of Nephrology

277

213

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Treatment of class VϩIV lupus nephritis remains unsatisfactory despite the progress made in the treatment of diffuse proliferative lupus nephritis. In this prospective study, 40 patients with class VϩIV lupus nephritis were randomly assigned to induction therapy with mycophenolate mofetil, tacrolimus, and steroids (multitarget therapy) or intravenous cyclophosphamide (IVCY). Patients were treated for 6 mo unless complete remission was not achieved, in which case treatment was extended to 9 mo. An intention-to-treat analysis revealed a higher rate of complete remission with multitarget therapy at both 6 and 9 mo (50 and 65%, respectively) than with IVCY (5 and 15%, respectively). At 6 mo, eight (40%) patients in each group experienced partial remission, and at 9 mo, six (30%) patients receiving multitarget therapy and eight (40%) patients receiving IVCY experienced partial remission. There were no deaths during this study. Most adverse events were less frequent in the multitarget therapy group. Calcineurin inhibitor nephrotoxicity was not observed, but three patients developed new-onset hypertension with multitarget therapy. In conclusion, multitarget therapy is superior to IVCY for inducing complete remission of class VϩIV lupus nephritis and is well tolerated.

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Section: Discussionmentioning

confidence: 99%

Successful Treatment of Class V+IV Lupus Nephritis with Multitarget Therapy

Bao

Liu

Xie

et al. 2008

Journal of the American Society of Nephrology

277

213

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“…On the basis of survival analysis, the cumulative relapse rate at 5 yr in our MMF-treated patients was approximately 40%. For comparison, we have reported that relapses occurred in 39% of patients on CTX-AZA treatment during 87 mo of follow-up (5), and other investigators have reported relapse rates of 41% over 4 yr or 37% over 5 yr in patients who were treated with CTX induction followed by AZA maintenance (26,27). In another study on patients who were treated with pulse cyclophosphamide, pulse methylprednisolone, or the combination of both, 45% of patients relapsed during 117 mo of follow-up (15).…”

Section: Discussionmentioning

confidence: 99%

Long-Term Study of Mycophenolate Mofetil as Continuous Induction and Maintenance Treatment for Diffuse Proliferative Lupus Nephritis

Chan¹,

Tse²,

Tang³

et al. 2005

Journal of the American Society of Nephrology

433

325

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Mycophenolate mofetil (MMF) and the sequential use of cyclophosphamide followed by azathioprine (CTX-AZA) demonstrate similar short-term efficacy in the treatment of diffuse proliferative lupus nephritis (DPLN), but MMF is associated with less drug toxicity. Results from an extended long-term study, with median follow-up of 63 mo, that investigated the role of MMF as continuous induction-maintenance treatment for DPLN are presented. Thirty-three patients were randomized to receive MMF, and 31 were randomized to the CTX-AZA treatment arm, both in combination with prednisolone. More than 90% in each group responded favorably (complete or partial remission) to induction treatment. Serum creatinine in both groups remained stable and comparable over time. Creatinine clearance increased significantly in the MMF group, but the between-group difference was insignificant. Improvements in serology and proteinuria were comparable between the two groups. A total of 6.3% in the MMF group and 10.0% of CTX-AZA-treated patients showed doubling of baseline creatinine during follow-up (P ‫؍‬ 0.667). Both the relapse-free survival and the hazard ratio for relapse were similar between MMF-and CTX-AZA-treated patients (11 and nine patients relapsed, respectively) and between those with MMF treatment for 12 or >24 mo. MMF treatment was associated with fewer infections and infections that required hospitalization (P ‫؍‬ 0.013 and 0.014, respectively). Four patients in the CTX-AZA group but none in the MMF group reached the composite end point of end-stage renal failure or death (P ‫؍‬ 0.062 by survival analysis). It is concluded that MMF and prednisolone constitute an effective continuous induction-maintenance treatment for DPLN in Chinese patients.

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“…[7][8][9][10][11] Despite the successful induction of proliferative GN, relapses are common, ranging from 10 to 65%. [12,13] Continued renal damage can adversely affect long-term renal survival with each relapse, [14] and the treatment of these relapses is burdened by the toxicity. Consequently, optimal treatment and duration of maintenance therapy remains a challenge.…”

Section: G M Sahin Et Almentioning

confidence: 99%

“…[13] Although long-term cyclophosphamide (CY) regimens are efficacious in the treatment of proliferative lupus nephritis and has improved the prognosis of disease in these patients, the safety of the regimen still limits the success of therapy. There has been increasing attention on developing alternate therapies that promptly and effectively induce remission, prevent relapse, and maximize patient and renal survival while incurring the least toxicity.…”

Section: Introductionmentioning

confidence: 99%

Mycophenolate Mofetil versus Azathioprine in the Maintenance Therapy of Lupus Nephritis

Şahin

Kızıltaş

et al. 2008

Renal Failure

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Background. Renal involvement is one of the major determinants of the outcome in patients with systemic lupus erythematosus. Renal involvement contributes to both morbidity and mortality of the patients as well as indirectly through side effects of therapy directed at the renal lesions. The aim of the study was to evaluate the efficacy of mycophenolate mofetil (MMF) and azathioprine (AZA) in the maintenance therapy of lupus nephritis. Methods. Thirty-two patients from our center with diagnosed lupus nephritis World Health Organization Class III, IV, V were treated with IVC (0.75-1g/month) for six months in addition to steroid therapy, and then with AZA (n = 15) or MMF (n = 17) as a maintenance therapy. The efficacy of two drugs was compared with changes in serum creatinine, creatinine clearance, 24 hour urine protein excretion, cholesterol, anti-dsDNA antibody, and urine sediment. Results. Mean follow-up time was 41.5 + 7 months. The total remission occurred in 84% of patients (82% with MMF and 87% with AZA), with a complete remission rate of 59.3% (58% with MMF and 60% with AZA) and a partial remission rate of 25% (22% with MMF and 27% with AZA). The urinary protein excretion before MMF treatment was 1.9 + 1 g/dL and decreased significantly to 0.91 + 0.6 g/dL (p = 0.028) after treatment, and decreased from 1.58 + 0.7g/dL to 0.4 + 0.23g/dL in the AZA group (p = 0.04). The serum creatinine level decreased from 1.32 + 0.7 mg/dL to 1.12 + 0.68 mg/dL in the MMF group (p = 0.23), and decreased from 0.91 + 0.23mg/dL to 0.88 + 0.23 mg/dL in the AZA group (p = 0.49). There was no significant change between two groups (p = 0.1). The serum cholesterol decreased from 229 + 57 mg/dL to 171 + 9 mg/dL (p = 0.002), and serum triglyceride level decreased from 228 + 116 mg/dL to 98 + 35 mg/dL (p = 0.004) in the MMF treatment, but no significant change was seen in AZA group. There was no significant difference between the two groups considering the rates of doubling of serum creatinine, progression to end-stage renal failure, relapses, and documented side effects, as well. Conclusion. Both therapeutic approaches with MMF or AZA, in combination with corticosteroids, are effective as a maintenance therapy for lupus nephritis.

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Relapses of lupus nephritis: incidence, risk factors, serology and impact on outcome

Cited by 88 publications

References 19 publications

Successful Treatment of Class V+IV Lupus Nephritis with Multitarget Therapy

Successful Treatment of Class V+IV Lupus Nephritis with Multitarget Therapy

Long-Term Study of Mycophenolate Mofetil as Continuous Induction and Maintenance Treatment for Diffuse Proliferative Lupus Nephritis

Mycophenolate Mofetil versus Azathioprine in the Maintenance Therapy of Lupus Nephritis

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