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

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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.

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Component of SDI and renal damage at 3 years.Percentage of corticosteroid-related or not corticosteroid-related damage of SDI in 4 groups was shown (p = 0.05). TAC group has higher corticosteroid-related damage than IVCY groups.
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pone.0175152.g006: Component of SDI and renal damage at 3 years.Percentage of corticosteroid-related or not corticosteroid-related damage of SDI in 4 groups was shown (p = 0.05). TAC group has higher corticosteroid-related damage than IVCY groups.

Mentions: We analysed SDI over 3 years among the four groups (Fig 4). The lowest damage accrual was found in patients on monthly IVCY. A higher percentage of patients with increasing damage accrual was seen in the TAC group compared with the monthly IVCY group (p = 0.04). We further analyzed the component of the damage. Fig 5 shows % change of eGFR from baseline and Fig 6 shows corticosteroid-related damage or not corticosteroid-related damage. Although there was statistically no significant difference in renal damage, TAC group tended to have higher percentage of corticosteroid-related damage (p = 0.05). Cumulative PSL dose for 3 years were compared among 4 groups (Fig 7). Relatively higher dose of PSL was found in TAC and MMF group without significant difference (monthly-IVCY, 12,002 ± 2,593 mg; ELNT-IVCY, 12,744 ± 3,983 mg; MMF, 14,013 ± 3,069 mg; TAC, 14,898 ± 4,653 mg).


Comparison of renal response to four different induction therapies in Japanese patients with lupus nephritis class III or IV: A single-centre retrospective study
Component of SDI and renal damage at 3 years.Percentage of corticosteroid-related or not corticosteroid-related damage of SDI in 4 groups was shown (p = 0.05). TAC group has higher corticosteroid-related damage than IVCY groups.
© Copyright Policy
Related In: Results  -  Collection

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

pone.0175152.g006: Component of SDI and renal damage at 3 years.Percentage of corticosteroid-related or not corticosteroid-related damage of SDI in 4 groups was shown (p = 0.05). TAC group has higher corticosteroid-related damage than IVCY groups.
Mentions: We analysed SDI over 3 years among the four groups (Fig 4). The lowest damage accrual was found in patients on monthly IVCY. A higher percentage of patients with increasing damage accrual was seen in the TAC group compared with the monthly IVCY group (p = 0.04). We further analyzed the component of the damage. Fig 5 shows % change of eGFR from baseline and Fig 6 shows corticosteroid-related damage or not corticosteroid-related damage. Although there was statistically no significant difference in renal damage, TAC group tended to have higher percentage of corticosteroid-related damage (p = 0.05). Cumulative PSL dose for 3 years were compared among 4 groups (Fig 7). Relatively higher dose of PSL was found in TAC and MMF group without significant difference (monthly-IVCY, 12,002 ± 2,593 mg; ELNT-IVCY, 12,744 ± 3,983 mg; MMF, 14,013 ± 3,069 mg; TAC, 14,898 ± 4,653 mg).

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