Treatment of membranous lupus nephritis with prednisone, azathioprine and                 cyclosporin A

Tam, Lai‐Shan; Ek, Li; Szeto, Cheuk‐Chun; Wong, SM; Cb, Leung; Fm, Lai; Kc, Wong; Lui, SL

doi:10.1177/096120330101001113

Cited by 15 publications

(16 citation statements)

References 7 publications

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“…6,[8][9][10][11]19,20,[23][24][25][26][27][28] Nephrotic proteinuria is found at diagnosis in a variable proportion of patients, and it usually evolves favourably with low percentages of death and/or ESRD at follow-up. 13,22,24,27,29 The percentage of poor outcomes does not seem to vary with the length of the follow-up, since the renal survival is similar independently of the follow-up of the cohort. What seems to adversely influence the outcome is the presence and persistence of a nephrotic syndrome and having mixed proliferative lesions.…”

Section: Discussionmentioning

confidence: 99%

Pure Membranous Lupus Nephritis: Description of a Cohort of 150 Patients and Review of the Literature

Silva-Fernández

Otón

Askanase

et al. 2019

Reumatología Clínica

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Section: Discussionmentioning

confidence: 99%

Pure Membranous Lupus Nephritis: Description of a Cohort of 150 Patients and Review of the Literature

Silva-Fernández

Otón

Askanase

et al. 2019

Reumatología Clínica

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“…As a whole, it can be stated that CyA treatment in proliferative lupus nephritis displays a cumulative rate of complete or partial remission approaching 90%, with an important antiproteinuric effect [85]. CyA has been proven to be effective also in the management of membranous lupus nephritis, even though evidence comes from small retrospective studies [86][87][88][89] and a single RCT comparing CyA to CTX as adjunctive treatments to steroids [90]. A 2014 metaanalysis considering CyA and tacrolimus has concluded that calcineurin inhibitors might be regarded as a reasonable alternative to CTX in the induction treatment of active lupus nephritis, with an higher rate of complete remission (relative risk [RR]=1.56) and a better response/total remission ratio (RR=1.23) [91].…”

Section: Cyclosporine a In Systemic Lupus Erythematosusmentioning

confidence: 99%

The Use of Cyclosporine A in Rheumatology: a 2016 Comprehensive Review

Chighizola

Ong

Meroni

2016

Clinic Rev Allerg Immunol

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Cyclosporine A, an inhibitor of calcineurin, exerts an immunomodulator action interfering with T cell activation. Even though novel therapeutic tools have emerged, CyA still represents a suitable option in several clinical rheumatology settings. This is the case of refractory nephritis and cytopenias associated with systemic lupus erythematosus. Furthermore, CyA is a valued therapeutic tool in the management of uveitis and thrombophlebitis in course of Behçet's disease. Topical CyA has been proven to be beneficial in the dry eye of Sjogren's syndrome, whereas oral treatment with CyA can be considered for the severe complications of adult onset Still's disease. CyA provides a therapeutic option in psoriatic arthritis, being rather effective in skin disease. CyA is currently regarded as a second-line option for patients with inflammatory myopathies refractory to standard regimen. CyA is used even in paediatric rheumatology, in particular in the management of juvenile dermatomyositis and macrophage activation syndrome associated with systemic juvenile idiopathic arthritis. Importantly, CyA has been shown to suppress the replication of HCV, and it can thus be safely prescribed to those patients with chronic hepatitis C. Noteworthy, CyA can be administered throughout the gestation course. Surely, caution should be paid to CyA safety profile, in particular to its nephrotoxicity. Even though most evidence comes from small and uncontrolled studies with few randomised controlled trials, CyA should be still regarded as a valid therapeutic tool in 2016 rheumatology.

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“…However, the renal remission rate with MMF therapy in the pure MLN group was 40%, comparable with 55% seen with cyclophosphamide therapy 7 and around 30-40% with cyclosporine therapy. 8,9 Despite comparable response rates, relapse rates have been high with cyclophosphamide (36%) 7 and cyclosporine (33%). 8,9 We observed a relapse in18% (2 of 11).…”

Section: Discussionmentioning

confidence: 99%

“…Cyclophosphamide and cyclosporine with concurrent glucocorticoid therapy have been used with varying success in MLN with remission rates ranging from 40-55%. [7][8][9] Studies of mycophenolate mofetil (MMF) in proliferative lupus nephritis have demonstrated its superiority in induction and maintenance compared with cyclophosphamide, with less toxicity. [10][11][12] However, evidence of the efficacy of MMF in MLN is limited.…”

Section: Introductionmentioning

confidence: 99%

Mycophenolate mofetil as the primary treatment of membranous lupus nephritis with and without concurrent proliferative disease: a retrospective study of 29 cases

Kasitanon

Petri

Haas

et al. 2008

Lupus

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Studies of immunosuppressive therapy, particularly mycophenolate mofetil (MMF), in membranous lupus nephritis (MLN) are limited. We report on our experience with primary (first-line) MMF therapy to induce and sustain renal remission in MLN with and without a concurrent proliferative lesion. Systemic lupus erythematosus (SLE) patients were studied, retrospectively, if treated with MMF for newly diagnosed MLN. Complete remission was defined as proteinuria less than 0.5 g/24 h, inactive urine sediment and normal estimated glomerular filtration rate. Response in pure MLN (Group I, n=10) was compared with mixed MLN and proliferative lupus nephritis (Group II, n=19). By 12 months, 4 (40%) patients in Group I and 7 (36.8%) in Group II achieved complete remission (P=0.87). One (10%) patient in Group I and 2 (10.5%) in Group II had worsening renal disease (P=0.97). Mean time to remission was more than seven months in both groups. The remaining patients had stable disease without improvement or worsening. Only 2 of 11 achieving initial remission had a relapse with an average of 28 months of follow-up after remission. Self-limited gastrointestinal symptoms occurred in 12 patients, none requiring withdrawal of the drug. Mycophenolate mofetil as a primary therapy in MLN was successful in inducing complete remission in about 40% of MLN, particularly in patients with mild proteinuria. However, 12 months of therapy was necessary for best outcomes. Response rate was not different in the presence or absence of a proliferative lesion.

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Treatment of membranous lupus nephritis with prednisone, azathioprine and cyclosporin A

Cited by 15 publications

References 7 publications

Pure Membranous Lupus Nephritis: Description of a Cohort of 150 Patients and Review of the Literature

Pure Membranous Lupus Nephritis: Description of a Cohort of 150 Patients and Review of the Literature

The Use of Cyclosporine A in Rheumatology: a 2016 Comprehensive Review

Mycophenolate mofetil as the primary treatment of membranous lupus nephritis with and without concurrent proliferative disease: a retrospective study of 29 cases

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