The economic impact of treatment of severe lupus nephritis with prednisone and intravenous cyclophosphamide

McInnes, Pamela; Schuttinga, James; Sanslone, William R.; Stark, Susan P.; Klippel, John H.

doi:10.1002/art.1780370704

Cited by 27 publications

(8 citation statements)

References 15 publications

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“…Furthermore, the concept of hypercoagulability in SLE patients has diverted the direction of therapy from immunosuppression [30] (as in the majority of our patients) towards anticoagulation [31]. Randomized trials have commenced in order to determine the optimal mode of therapy for SLE patients under strict inclusion criteria, based on well-defined patient categories.…”

Section: Discussionmentioning

confidence: 99%

Brain glucose utilization in systemic lupus erythematosus with neuropsychiatric symptoms: A controlled positron emission tomography study

et al. 1997

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Abstract. In contrast to morphological imaging [such as magnetic resonance imaging (MRI) or computed tomography], functional imaging may be of advantage in the detection of brain abnormalities in cases of neuropsyehiatric systemic lupus erythematosus (SLE). Therefore, we studied 13 patients (aged 40_+14 years, 11 female, 2 male) with neuropsychiatric SLE who met four of the American Rheumatism Association criteria for the classification of SLE. Ten clinically and neurologically healthy volunteers served as controls (aged 40+12 years, 5 female, 5 male). Both groups were investigated using fluorine-18-1abelled fluorodeoxyglucose brain positron emission tomography (PET) and cranial MRI. The normal controls and 11 of the 13 patients showed normal MRI scans. However, PET scan was abnormal in all 13 SLE patients. Significant group-to-group differences in the glucose metabolic index (GMI=region of interest uptake/global uptake at the level of the basal ganglia and thalamus) were found in the parieto-occipital region on both sides: the GMI of the parieto-oceipital region on the right side was 0.922+0.045 in patients and 1.066+0.081 in controls (P<0.0001, Mann Whitney U test), while on the left side it was 0.892+0.060 in patients and 1.034+0.051 in controls (P=0.0002). Parietooccipital hypometabolism is a conspicuous finding in mainly MRl-negative neuropsychiatric SLE. As the parieto-occipital region is located at the boundary of blood supply of all three major arteries, it could be the most vulnerable zone of the cerebrum and may be affected at an early stage of the cerebrovascular disease.

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Section: Discussionmentioning

confidence: 99%

Brain glucose utilization in systemic lupus erythematosus with neuropsychiatric symptoms: A controlled positron emission tomography study

et al. 1997

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“…In lupus, there is one study that assessed the economic impact of treatment on working capacity in lupus patients and compared the effects of treatment of severe lupus nephritis treated with prednisone and intravenous cyclophosphamide with those of prednisone alone. In that study, it was estimated that the savings gain attributable to working capacity alone would be $42.3 million over 10 years (40).…”

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confidence: 99%

Work disability in systemic lupus erythematosus

Dhanhani¹,

Gignac²,

Su³

et al. 2009

Arthritis & Rheumatism

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Objective. To determine the prevalence, accrual over time, and risk factors of work disability in patients with systemic lupus erythematosus (SLE). Methods. We studied 432 patients from an inception cohort. Work disability was measured from a single self-report question. Results. Of 432 patients, 88% were women and 73% were white. Within the first year of diagnosis, 47% of patients were employed, 7% had a disability, and 7% were on sick leave. Overall, work disability was found in 98 (23%) patients. Risk factors for work disability found in the multivariate regression analysis were younger age at diagnosis, less education, fibromyalgia, hypertension, higher first-visit SLEDAI-2K score, and lower first-visit SF-36 score. Conclusion. Work disability is frequent in patients with SLE, with a cumulative prevalence of 23%. Work disability was associated with a complex array of health factors, including comorbidity, physical and mental health limitations, and clinical features of lupus, that warrant increased attention in future research.

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“…The use of immunosuppressive agents has been associated with a better prognosis (5-12). Combined cyclophosphamide (CYC) and glucocorticoid therapy is deemed to yield significant improvement in renal survival (13)(14)(15) and positive economic impact, compared with glucocorticoid therapy alone (16). However, several questions regarding the use of CYC in lupus nephritis remain unresolved.…”

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confidence: 99%

Cumulative rate of relapse of lupus nephritis after successful treatment with cyclophosphamide

Ciruelo

Cruz

López

et al. 1996

Arthritis & Rheumatism

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Objective. To determine the cumulative rate of relapse of lupus nephritis that has been treated successfully with cyclophosphamide (CYC), and to estimate the association between time to relapse and demographic, clinical, laboratory, and treatment variables.Methods. This was an observational study of 48 systemic lupus erythematosus (SLE) patients who were treated successfully with CYC between 1979 and 1993 and followed up thereafter a t 3 university hospitals. Demographic and clinical variables, laboratory data during the first month of nephritis, and therapy-related variables were recorded from charts. Renal biopsy specimens were retrieved and analyzed by a pathologist. Relapse of nephritis was the outcome of interest. Descriptive analysis of patients who did and those who did not have a relapse was performed by chi-square test, Fisher's exact test, and Wilcoxon 2-sample test. The cumulative rate of relapse was computed using the actuarial method. Univariate comparisons of time to relapse were computed by log-rank test. Proportional hazards modeling was used to assess the combined effect of patient characteristics that have been hypothesized to be prognostic factors.ResuZts. Nephritis relapsed in 11 patients. Previous hematologic disorder, arthritis or arthralgia, and the use of CYC in oral form were more frequent in patients who had a relapse. The cumulative rate of relapse was 25% and 46% at 5 years and 10 years, respectively. A significant univariate difference in time to relapse was found when patients were stratified by Renal disease is a major cause of morbidity and mortality in systemic lupus erythematosus (SLE) (1-4). The use of immunosuppressive agents has been associated with a better prognosis (5-12). Combined cyclophosphamide (CYC) and glucocorticoid therapy is deemed to yield significant improvement in renal survival (13-15) and positive economic impact, compared with glucocorticoid therapy alone (16). However, several questions regarding the use of CYC in lupus nephritis remain unresolved. The optimum dosage, length of therapy, and method of administration have not been fully established. Toxicity and side effects are major limiting factors.The rate of relapse of nephritis following CYC therapy is largely unknown. This issue is important because recurrent episodes of nephritis may lead to progressive renal failure. In various studies, the rate of relapse of nephritis has ranged between 0 and 50%. However, followup of patients in these studies was short or was not mentioned in the reports (11,13,(17)(18)(19). Boumpas et a1 (20) and found that short courses of intravenous CYC pulses were associated with a higher rate of disease exacerbation than were longer courses. Information regarding the influence of demographic and clinical variables, renal histology, and methods of CYC administration is lack-

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The economic impact of treatment of severe lupus nephritis with prednisone and intravenous cyclophosphamide

Cited by 27 publications

References 15 publications

Brain glucose utilization in systemic lupus erythematosus with neuropsychiatric symptoms: A controlled positron emission tomography study

Brain glucose utilization in systemic lupus erythematosus with neuropsychiatric symptoms: A controlled positron emission tomography study

Work disability in systemic lupus erythematosus

Cumulative rate of relapse of lupus nephritis after successful treatment with cyclophosphamide

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