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Intravenous cyclophosphamide combined with steroids in pediatric onset severe lupus nephritis.

Vachvanichsanong P, Dissaneewate P, McNeil E - Int Urol Nephrol (2012)

Bottom Line: Both groups responded well initially to treatment; proteinuria reduced to normal levels after 1 and 2 treatments in the normal and abnormal groups, respectively, while creatinine clearance returned to normal levels after 8 treatments in the abnormal group.At the time of analysis, some patients who had completed their IVCY course still required other therapy to control their disease activity.Immediate outcomes were favorable but long-term remission was not promising.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, 90110, Songkla, Thailand, vprayong@gmail.com.

ABSTRACT

Background: Intravenous cyclophosphamide (IVCY) has been used to treat severe lupus nephritis (LN) for many years. Because of the wide variety of manifestations of the condition and the long-term nature of the disease, outcomes vary widely.

Objective: To evaluate and compare the immediate and long-term results of IVCY in pediatric onset severe LN and between patients with normal and abnormal initial renal function.

Methods: Patients aged <18 years who attended the Department of Pediatrics, Prince of Songkla University, diagnosed with severe LN, and who were given a 36-month IVCY course, were included. Comparison of overall survival between the two groups was assessed using Kaplan-Meier survival curves.

Results: 108 patients with a mean age of 12.6 ± 2.7 years were studied, with a mean follow-up time of 5.7 ± 4.3 years. 48 patients completed the IVCY course. 36 patients had abnormal renal function and 72 patients had normal renal function at the start of therapy. Both groups responded well initially to treatment; proteinuria reduced to normal levels after 1 and 2 treatments in the normal and abnormal groups, respectively, while creatinine clearance returned to normal levels after 8 treatments in the abnormal group. Overall survival was not different between the two groups; however, the abnormal renal function group had a higher crude mortality rate than the normal group (13/36 vs 10/72, p value = 0.02). At the time of analysis, some patients who had completed their IVCY course still required other therapy to control their disease activity.

Conclusion: Three years of IVCY treatment provided similar outcomes in both normal and abnormal renal function groups. Immediate outcomes were favorable but long-term remission was not promising.

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Related in: MedlinePlus

Survival curve of SLE patients treated with IVCY by initial renal function group
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Related In: Results  -  Collection


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Fig2: Survival curve of SLE patients treated with IVCY by initial renal function group

Mentions: Figure 2 shows the patient survival curve of SLE patients separated by initial renal function group from the start of treatment with IVCY. There was no significant difference in overall survival between the two groups, although the crude mortality rate was higher in the group of patients who had abnormal renal function at the start of treatment (10/72 vs 13/36, p value = 0.02). The overall survival rates at 2 and 5 years were 93 % (n = 77, 95 % CI: 87–98 %) and 78 % (n = 42, 95 % CI: 70–88 %), respectively. The median survival time of the normal renal function group was undefined. For the abnormal renal function group, the median survival time was 8.7 years (p = 0.15).Fig. 2


Intravenous cyclophosphamide combined with steroids in pediatric onset severe lupus nephritis.

Vachvanichsanong P, Dissaneewate P, McNeil E - Int Urol Nephrol (2012)

Survival curve of SLE patients treated with IVCY by initial renal function group
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3824347&req=5

Fig2: Survival curve of SLE patients treated with IVCY by initial renal function group
Mentions: Figure 2 shows the patient survival curve of SLE patients separated by initial renal function group from the start of treatment with IVCY. There was no significant difference in overall survival between the two groups, although the crude mortality rate was higher in the group of patients who had abnormal renal function at the start of treatment (10/72 vs 13/36, p value = 0.02). The overall survival rates at 2 and 5 years were 93 % (n = 77, 95 % CI: 87–98 %) and 78 % (n = 42, 95 % CI: 70–88 %), respectively. The median survival time of the normal renal function group was undefined. For the abnormal renal function group, the median survival time was 8.7 years (p = 0.15).Fig. 2

Bottom Line: Both groups responded well initially to treatment; proteinuria reduced to normal levels after 1 and 2 treatments in the normal and abnormal groups, respectively, while creatinine clearance returned to normal levels after 8 treatments in the abnormal group.At the time of analysis, some patients who had completed their IVCY course still required other therapy to control their disease activity.Immediate outcomes were favorable but long-term remission was not promising.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, 90110, Songkla, Thailand, vprayong@gmail.com.

ABSTRACT

Background: Intravenous cyclophosphamide (IVCY) has been used to treat severe lupus nephritis (LN) for many years. Because of the wide variety of manifestations of the condition and the long-term nature of the disease, outcomes vary widely.

Objective: To evaluate and compare the immediate and long-term results of IVCY in pediatric onset severe LN and between patients with normal and abnormal initial renal function.

Methods: Patients aged <18 years who attended the Department of Pediatrics, Prince of Songkla University, diagnosed with severe LN, and who were given a 36-month IVCY course, were included. Comparison of overall survival between the two groups was assessed using Kaplan-Meier survival curves.

Results: 108 patients with a mean age of 12.6 ± 2.7 years were studied, with a mean follow-up time of 5.7 ± 4.3 years. 48 patients completed the IVCY course. 36 patients had abnormal renal function and 72 patients had normal renal function at the start of therapy. Both groups responded well initially to treatment; proteinuria reduced to normal levels after 1 and 2 treatments in the normal and abnormal groups, respectively, while creatinine clearance returned to normal levels after 8 treatments in the abnormal group. Overall survival was not different between the two groups; however, the abnormal renal function group had a higher crude mortality rate than the normal group (13/36 vs 10/72, p value = 0.02). At the time of analysis, some patients who had completed their IVCY course still required other therapy to control their disease activity.

Conclusion: Three years of IVCY treatment provided similar outcomes in both normal and abnormal renal function groups. Immediate outcomes were favorable but long-term remission was not promising.

Show MeSH
Related in: MedlinePlus