Treatment of pure membranous lupus nephropathy with prednisone and azathioprine: an open-label trial

Mok, Chi Chiu; Ying, King Yee; Lau, Chak Sing; Yim, Cheuk Wan; Ng, Woon Leung; Wong, Wing Sze; Au, Tak Cheung

doi:10.1053/j.ajkd.2003.10.029

Cited by 70 publications

(49 citation statements)

References 17 publications

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“…Moroni et al (96), in a small retrospective analysis, reported that MP and chlorambucil (given alternated month for 6 mo) may induce a more stable remission of nephrotic syndrome and may better prevent renal impairment in comparison with GC alone. In a recent open-label trial, Mok et al (97) treated 38 patients with GC and AZA. At 12 mo, 67 and 22% of the patients achieved complete and partial remission, respectively.…”

Section: Membranous Lnmentioning

confidence: 99%

Management of Lupus Nephritis

Houssiau¹

2004

Journal of the American Society of Nephrology

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Section: Membranous Lnmentioning

confidence: 99%

Management of Lupus Nephritis

Houssiau¹

2004

Journal of the American Society of Nephrology

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“…Notwithstanding these limitations, it is generally agreed that patients with low levels of proteinuria, stable kidney function, low serological activity, no evidence or risk of concomitant severe proliferative features based on clinical judgment and an adequate renal biopsy should be managed with blood pressure control and renin-angiotensin pathway blockade, while patients with nephrotic and/or increasing proteinuria despite conservative management warrant an escalation of immunosuppressive therapy to aim for induction of proteinuria response [38,47]. The latter should be a combination of corticosteroids and any one of the following, CYC, AZA, MPA or a calcineurin inhibitor, and the efficacy of these treatment regimens has been observed in Asian patients [34,48,49,50]. …”

Section: Current Immunosuppressive Treatments For Ln: An Asian Perspementioning

confidence: 99%

Lupus Nephritis in Asia: Clinical Features and Management

Yap

Chan²

2015

Kidney Dis

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Background: Lupus nephritis (LN) is a common and severe organ involvement manifesting itself in systemic lupus erythematosus (SLE). There is a considerable difference in prevalence, severity, treatment response and outcomes between Asian LN patients and LN patients from other racial backgrounds. Summary: Asian SLE patients have a higher prevalence of LN than Caucasian SLE patients and often present with a more severe disease. Increasing data from genetic studies, accompanied by progress in high-throughput genotyping, have advanced our knowledge about genetic predispositions that might partly contribute to the clinical variations observed. Corticosteroids combined with either cyclophosphamide (CYC) or mycophenolic acid (MPA) is the current standard-of-care induction regimen for severe LN irrespective of race or ethnicity. However, the preference for MPA or CYC, and possibly the optimum dose for MPA, is influenced by the patient's origin. Also, there is an insufficient evidence base for reduced-dose intravenous CYC in Asian patients. Health economics and access to prompt diagnosis and treatment are still challenging issues in some Asian regions. The former represents a significant obstacle limiting the access of patients to MPA despite the proven efficacy of the drug as an induction agent and its superiority over azathioprine (AZA) in preventing disease flares when used for long-term maintenance immunosuppression. Calcineurin inhibitors such as tacrolimus deserve further investigation in view of their additional effect on podocytes by reducing proteinuria and the promising data from Asian patients. Despite considerable advances in the clinical management of LN over the past few decades with resultant improvements in patients' outcomes, there are still knowledge gaps and unmet clinical needs. Asia has made substantial contributions to the evidence base that guides clinical management and continues to offer invaluable opportunities for research pursuits. Key Messages: Treatment responses and clinical outcomes in Asian patients with LN compare favorably with patients from other parts of the world. The prevention and treatment of infective complications remain significant challenges in managing LN in Asia. Facts from East and West: (1) The prevalence of SLE is lower among Caucasians than other ethnicities. A higher prevalence is observed among Asians and African Americans, while the highest prevalence is found in Caribbean people. The prevalence of LN in Asian SLE patients is much higher than in Caucasians as well. However, the 10-year renal outcome and renal survival rate appear to be better in Asians. (2) Polymorphisms of genes involved in the immune response, such as Fcγ receptor, integrin alpha M, TNF superfamily 4, myotubularin-related protein 3 and many others, might be partly responsible for the differences in prevalence between the different ethnic groups. European ancestry was shown to be associated with a decrease in the risk of LN even after adjustment for genes most associated with renal disease. (3) Access...

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“…85,164 Combination therapies with corticosteroids plus cyclophosphamide, azathioprine, mycophenolate mofetil, or a calcineurin inhibitor have all demonstrated efficacy. 62,63,[85][86][87][164][165][166] However, treatment with corticosteroids and a calcineurin inhibitor needs to be longterm, for a minimum of 1-2 years, and is associated with a high relapse rate after discontinuation. High-dose cortico steroids, combined with mycophenolate mofetil or cyclophosphamide might offer the advantage of inducing sustained remission in some patients.…”

Section: Induction Treatmentmentioning

confidence: 99%

“…62,123,124 Corticosteroids combined with sequential therapy (cyclophosphamide then azathioprine), or combined with azathioprine, might alternatively be considered in Asian patients. 165,166 In patients with persistent proteinuria despite immunosuppressive treatment, additional therapies are important to prevent thromboembolic complications and control risk factors for cardiovascular disease.…”

Section: Induction Treatmentmentioning

confidence: 99%

Treatment of severe lupus nephritis: the new horizon

Chan

2014

Nat Rev Nephrol

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Lupus nephritis is a common and severe manifestation of systemic lupus erythematosus, and an important cause of both acute kidney injury and end-stage renal disease. Despite its aggressive course, lupus nephritis is amenable to treatment in the majority of patients. The paradigm of immunosuppressive treatment for lupus nephritis has evolved over the past few decades from corticosteroids alone to corticosteroids combined with cyclophosphamide. Sequential treatment regimens using various agents have been formulated for induction and long-term maintenance therapy, and mycophenolate mofetil has emerged as a standard of care option for both induction and maintenance immunosuppressive treatment. The current era has witnessed the emergence of multiple novel therapeutic options, such as calcineurin inhibitors and biologic agents that target key pathogenetic mechanisms of lupus nephritis. Clinical outcomes have improved in parallel with these therapeutic advances. This Review discusses the evidence in support of current standard of care immunosuppressive treatments and emerging therapies, and describes their roles and relative merits in the management of patients with lupus nephritis.

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Treatment of pure membranous lupus nephropathy with prednisone and azathioprine: an open-label trial

Cited by 70 publications

References 17 publications

Management of Lupus Nephritis

Management of Lupus Nephritis

Lupus Nephritis in Asia: Clinical Features and Management

Treatment of severe lupus nephritis: the new horizon

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