Journal Article

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

Kiyokawa, Tomofumi, Iida, Harunobu, Yamada, Hidehiro, Shirai, Sayuri, Koike, Junki, Takakuwa, Yukiko, Ishimori, Kana, Ozaki, Shoichi, Ichikawa, Daisuke, Hanaoka, Hironari, Okazaki, Takahiro

2017

Overview

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.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Adult / Arthritis / Atrophy / Autoimmune diseases / Biology and Life Sciences / Biopsy / Care and treatment / Chronic conditions / Classification / Classification (sedimentation) / Clinical trials / Corticosteroids / Creatinine / Cyclophosphamide / Damage assessment / Data acquisition / Data collection / Dialysis / Edetic acid / Effectiveness / Epidermal growth factor receptors / Ethylenediaminetetraacetic acids / Female / Fibrosis / Frontotemporal dementia / Glomerular filtration rate / Glomerulonephritis / Health aspects / Health risk assessment / Humans / Hypertension / Immunofluorescence / Immunosuppressive agents / Immunosuppressive Agents - therapeutic use / Induction therapy / Infiltration / Intervention / Japan / Japanese (Asian people) / Kidney diseases / Kidney transplantation / Light microscopy / Lupus / Lupus Nephritis - pathology / Lupus Nephritis - therapy / Male / Management / Medicine / Medicine and Health Sciences / Microscopy / Middle Aged / Minority & ethnic groups / Mortality / Multivariate analysis / Nephritis / Pathology / Pharmacokinetics / Pharmacology / Phenols / Physical Sciences / Physicians / Populations / Prognosis / Protocol (computers) / Renal function / Research and Analysis Methods / Retrospective Studies / Safety / Statistical analysis / Survival / Systemic lupus erythematosus / Tacrolimus / Therapeutics / Therapy / Urine