Limits...
Comparison of renal response to four different induction therapies in Japanese patients with lupus nephritis class III or IV: A single-centre retrospective study

View Article: PubMed Central - PubMed

ABSTRACT

The recent recommendations for the management of lupus nephritis suggest that racial background should be considered while choosing induction therapy. However, the responses to different induction regimens have been poorly studied in Japanese population. Here, we assessed the renal response to different induction therapies in Japanese patients with lupus nephritis class III or IV. The records of 64 patients with biopsy-proven lupus nephritis class III or IV were retrospectively evaluated according to therapy received: monthly intravenous cyclophosphamide (IVCY), the Euro-lupus nephritis trial (ELNT) protocol-IVCY, tacrolimus (TAC), or mycophenolate mofetil (MMF). We investigated cumulative complete renal response (CR) rates and relapse rates for each group for 3 years. Organ damage was assessed with the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI). There were 22 patients on monthly IVCY, 18 on ELNT-IVCY, 13 on TAC, and 11 on MMF. Lower systemic lupus erythematosus disease activity index (SLEDAI) and higher CH50 were found in the TAC group at baseline (p<0.01 and p<0.01, respectively). There were no significant differences of cumulative CR rates and relapse free survival for 3 years among the four different therapeutic regimens (p = 0.2 and p = 0.2, respectively). There was a tendency to have early response and early relapse in TAC group and late response in MMF group. The SDI increase over 3 years was found more frequently in the TAC group than in the monthly-IVCY group (p = 0.04). Multivariate analysis indicated that CR at 3 months was independent prognosticator for low damage accrual. Regarding lower damage accrual, early CR achievement might be essential in induction therapy regardless of immunosuppressant choice.

No MeSH data available.


Related in: MedlinePlus

Relapse free rate for 3 years after CR achievement.There was no significant difference among the four treatment groups. CR, Complete renal response; IVCY, intravenous cyclophosphamide; ELNT, Euro-Lupus Nephritis Trial; TAC, Tacrolimus; MMF, mycophenolate mofetil.
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC5383240&req=5

pone.0175152.g003: Relapse free rate for 3 years after CR achievement.There was no significant difference among the four treatment groups. CR, Complete renal response; IVCY, intravenous cyclophosphamide; ELNT, Euro-Lupus Nephritis Trial; TAC, Tacrolimus; MMF, mycophenolate mofetil.

Mentions: We next focused on renal response. Fig 1 shows cumulative CR rates of the four treatment groups. Cumulative CR rates over 3 years were not significantly different among the four groups (monthly-IVCY 95.5%, low-dose ELNT-IVCY 77.8%, MMF 81.8%, and TAC 84.6%, p = 0.2). However, renal response was relatively earlier with TAC and later with MMF compared with the IVCY groups. In IVCY group, there was almost the same renal response by 48 weeks between monthly and ELNT-IVCY but CR rate of monthly-IVCY kept to increase for 3 years compared with ELNT-IVCY. We further investigated the relapse free rate over 3 years from the study enrolment (Fig 2) and the time CR achievement (Fig 3), and found no significant differences among the four groups (p = 0.2 and p = 0.6, respectively). Interestingly, patients with TAC displayed an early renal response for the first year after the induction therapy, but they showed an early relapse.


Comparison of renal response to four different induction therapies in Japanese patients with lupus nephritis class III or IV: A single-centre retrospective study
Relapse free rate for 3 years after CR achievement.There was no significant difference among the four treatment groups. CR, Complete renal response; IVCY, intravenous cyclophosphamide; ELNT, Euro-Lupus Nephritis Trial; TAC, Tacrolimus; MMF, mycophenolate mofetil.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5383240&req=5

pone.0175152.g003: Relapse free rate for 3 years after CR achievement.There was no significant difference among the four treatment groups. CR, Complete renal response; IVCY, intravenous cyclophosphamide; ELNT, Euro-Lupus Nephritis Trial; TAC, Tacrolimus; MMF, mycophenolate mofetil.
Mentions: We next focused on renal response. Fig 1 shows cumulative CR rates of the four treatment groups. Cumulative CR rates over 3 years were not significantly different among the four groups (monthly-IVCY 95.5%, low-dose ELNT-IVCY 77.8%, MMF 81.8%, and TAC 84.6%, p = 0.2). However, renal response was relatively earlier with TAC and later with MMF compared with the IVCY groups. In IVCY group, there was almost the same renal response by 48 weeks between monthly and ELNT-IVCY but CR rate of monthly-IVCY kept to increase for 3 years compared with ELNT-IVCY. We further investigated the relapse free rate over 3 years from the study enrolment (Fig 2) and the time CR achievement (Fig 3), and found no significant differences among the four groups (p = 0.2 and p = 0.6, respectively). Interestingly, patients with TAC displayed an early renal response for the first year after the induction therapy, but they showed an early relapse.

View Article: PubMed Central - PubMed

ABSTRACT

The recent recommendations for the management of lupus nephritis suggest that racial background should be considered while choosing induction therapy. However, the responses to different induction regimens have been poorly studied in Japanese population. Here, we assessed the renal response to different induction therapies in Japanese patients with lupus nephritis class III or IV. The records of 64 patients with biopsy-proven lupus nephritis class III or IV were retrospectively evaluated according to therapy received: monthly intravenous cyclophosphamide (IVCY), the Euro-lupus nephritis trial (ELNT) protocol-IVCY, tacrolimus (TAC), or mycophenolate mofetil (MMF). We investigated cumulative complete renal response (CR) rates and relapse rates for each group for 3 years. Organ damage was assessed with the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI). There were 22 patients on monthly IVCY, 18 on ELNT-IVCY, 13 on TAC, and 11 on MMF. Lower systemic lupus erythematosus disease activity index (SLEDAI) and higher CH50 were found in the TAC group at baseline (p<0.01 and p<0.01, respectively). There were no significant differences of cumulative CR rates and relapse free survival for 3 years among the four different therapeutic regimens (p = 0.2 and p = 0.2, respectively). There was a tendency to have early response and early relapse in TAC group and late response in MMF group. The SDI increase over 3 years was found more frequently in the TAC group than in the monthly-IVCY group (p = 0.04). Multivariate analysis indicated that CR at 3 months was independent prognosticator for low damage accrual. Regarding lower damage accrual, early CR achievement might be essential in induction therapy regardless of immunosuppressant choice.

No MeSH data available.


Related in: MedlinePlus