Revisited Cyclophosphamide in the Treatment of Lupus Nephritis

Quan, Xiao-ying; Chen, Hao-tao; Liang, Si-qin; Yang, Chen; Yao, Cui‐Wei; Xu, Yong‐Zhi; Liu, Huafeng; Yang, Chen

doi:10.1155/2022/8345737

Cited by 16 publications

(10 citation statements)

References 78 publications

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“…If the condition reaches partial or complete remission, maintenance treatment can be implemented with a course of six to 24 months. Patients with complete remission can gradually reduce or terminate treatment within one year, while patients with partial remission need to continue maintenance treatment [14,15].…”

Section: Discussionmentioning

confidence: 99%

“…Despite the emergence of new biological agents, CYC is still the first-line drug widely used to treat patients with severe LN. Its combination with glucocorticoids can be more effective in preventing doubling serum creatinine levels than glucocorticoids alone [14,16]. However, in some patients, treatment has to be stopped due to infection onset, liver damage, bone marrow suppression, and leukopenia [14,16].…”

Section: Discussionmentioning

confidence: 99%

“…Its combination with glucocorticoids can be more effective in preventing doubling serum creatinine levels than glucocorticoids alone [14,16]. However, in some patients, treatment has to be stopped due to infection onset, liver damage, bone marrow suppression, and leukopenia [14,16]. Considering our patient's recurring infection episodes, the choice to persist with immunosuppression was consistently guided by an assessment of the disease's progression.…”

Section: Discussionmentioning

confidence: 99%

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Stroke and Multiorgan Failure as the Initial Manifestations of Lupus

Costa,

Silva,

Carones

et al. 2024

Cureus

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Systemic lupus erythematosus (SLE) is a persistent autoimmune disorder that manifests across a spectrum ranging from mild to severe disease, often requiring hospitalization and critical care management. We present a severe case of systemic involvement at its onset. A young woman, with a background of arterial hypertension, presented to the emergency department exhibiting a total anterior circulation stroke and exuberant symmetric lower limb edema. Her condition rapidly deteriorated with neurological impairment, respiratory failure requiring mechanical ventilation, and acute kidney injury prompting her admission to the ICU. Following clinical investigation, a diagnosis of SLE was established, according to the European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) 2019 and Systemic Lupus International Collaborating Clinics (SLICC) 2012 classification criteria. The patient underwent treatment involving high-dose corticosteroids, followed by the Euro-Lupus protocol, resulting in significant improvement, despite her severe neurological deficit at admission. Lupus is a complex disease that is often difficult to diagnose because of its potential to mimic various other conditions. Our report delves into a case of previously undiagnosed lupus leading the patient to the ICU. The clinical scenario described adds valuable insights to the understanding of lupus-related complications and their management through a multidisciplinary approach.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Stroke and Multiorgan Failure as the Initial Manifestations of Lupus

Costa,

Silva,

Carones

et al. 2024

Cureus

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“…The liver is susceptible to varying degrees of damage, and it has been estimated that drug-related liver injury accounts for 10% to 15% of overall drug-related illness. In SLE patients, long-term and heavy application of immunosuppressives can lead to various adverse effects [29]. Among which, the use of cyclophosphamide may result in a decrease in the number of white blood cells and platelets, gonadal damage and hepatotoxicity [30,31].…”

Section: Discussionmentioning

confidence: 99%

Efficacy of total glucosides of paeony on Chinese patients with systemic lupus erythematosus: a propensity-matched study

Li,

Yu,

et al. 2023

Preprint

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Background To evaluate the real-world efficacy of total peony glycoside (TGP) treatment in patients with systemic lupus erythematosus (SLE). Methods A retrospective cohort analysis was conducted to evaluate the efficacy of TGP (administered for a minimum of 3 months) in SLE patients hospitalized to Nanjing Drum Tower Hospital between 2009 and 2021, using propensity score matching method. A total of 244 patients were included, of which differences in variables between the TGP-treated and non-TGP-treated groups were compared. To minimize the effect of confounding factors, multivariate logistic regression analysis was applied. Results Baseline variables were similar between the TGP and non-TGP groups, except for lower rates of cyclophosphamide and tripterygium glycoside administration in the TGP group. The median follow-up times for the two groups were 28.9 and 24.8 months, respectively. Compared with the control group, TGP treatment resulted in significantly improved musculoskeletal and mucocutaneous involvement. Meanwhile, patients in the TGP group exhibited elevated serum albumin levels and reduced total bile acid levels even after adjustment (OR = 2.43 and 2.44, p < 0.01). Conclusion TGP has shown potential beneficial in certain SLE patients, particularly those with musculoskeletal and mucocutaneous manifestations, as well as individuals liver dysfunction. Trial registration The study was conducted in accordance with the Declaration of Helsinki, and approved by the Ethics Committee of Nanjing Drum Tower Hospital (No. 2022-220-02).

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“…Sodium 2-mercaptoethane sulfonate also known as (MESNA), is a bladder protective agent to prevent hemorrhagic cystitis with high-dose CYC dosing of 3-7 g/m 2 and may not be necessary for the doses used in lupus nephritis [29,30,34,35].…”

Section: Cyclophosphamidementioning

confidence: 99%

New guidelines and therapeutic updates for the management of lupus nephritis

Desai,

Ahdoot,

Malik

et al. 2024

Current Opinion in Nephrology &Amp; Hypertension

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Purpose of review Systemic lupus erythematosus (SLE) can be a devastating condition, striking young patients often in their prime reproductive years. Lupus nephritis is a common and serious complication occurring in roughly 50% of SLE cases, indicating a high likelihood of disease progression, morbidity, and mortality. As the early trials of steroid therapy, and later cyclophosphamide (CYC), therapeutic changes had been stagnant. Then came the introduction of mycophenolate mofetil (MMF) in the 2000s. After the Aspreva Lupus Management Study, there had been a dearth of trials showing positive therapy results. Since 2020, new studies have emerged for lupus nephritis involving the use of anti-BLYS agents, novel calcineurin inhibitors, CD20 blockade, and antiinterferon agents. Nephrology and rheumatology society guidelines in the United States and across the world are still catching up. Recent findings Although therapeutic guidelines are being developed, updates that have come through have focused on improved diagnostic and monitoring guidelines. One theme is the recommendation of increasingly tight proteinuria control and firmer guidelines for the rapid induction of remission. The reality of multitarget therapy and the expectation of rapid induction for a more complete remission are being widely recognized. Summary The need for more complete and more rapid induction and control of lupus nephritis is undisputed according to the evidence and guidelines, and the medications to achieve this are growing at a rate not seen over the prior two decades. What remains is a stepwise approach to recognize how to best optimize therapy. Based on available evidence, an algorithm for induction and maintenance treatment of lupus nephritis used by the University of California Irvine Lupus Nephritis clinic, is recommended.

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Revisited Cyclophosphamide in the Treatment of Lupus Nephritis

Cited by 16 publications

References 78 publications

Stroke and Multiorgan Failure as the Initial Manifestations of Lupus

Stroke and Multiorgan Failure as the Initial Manifestations of Lupus

Efficacy of total glucosides of paeony on Chinese patients with systemic lupus erythematosus: a propensity-matched study

New guidelines and therapeutic updates for the management of lupus nephritis

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