Good outcomes with mycophenolate-cyclosporine-based induction protocol in children with severe proliferative lupus nephritis.

Abstract

The outcomes of children with severe proliferative lupus nephritis (LN) were examined using a new mycophenolate and cyclosporine-based (MMF-CSA) induction protocol. Sixteen children with LN (WHO class III and IV), 31.3% of whom required dialysis at induction, were retrospectively studied. Median MMF dose was 942 mg/m( 2)/day. Thirteen patients (81%) with persistent proteinuria received CSA. Clinical and laboratory parameters were compared at pre-induction, 6 and 12 months. Treatment outcome was defined by Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), renal function, haematuria, proteinuria and serological markers (complements C3, C4 and anti-dsDNA). Comparing these parameters at induction, 6 months and 12 months, respectively, SLEDAI (25.4 +/- 8.7 versus 3.2 +/- 2.9 versus 2.9 +/- 2.8), serum C3 (47 +/- 21 versus 107 +/- 27 versus 111 +/- 38 mg/dl), C4 (12 +/- 14 versus 23 +/- 14 versus 22 +/- 11 mg/dl) and urine protein (6.97 +/- 7.09 versus 0.98 +/- 1.56 versus 0.21 +/- 0.13 g/ day/1. 73 m(2)) improved significantly (p < 0.05). Anti-dsDNA titres decreased in 73% by 6 and 12 months (p < 0.05). Complete renal remission was achieved in 7/16 (43.8%) at 6 months and 12/16 (75%) at 12 months, the rest achieving partial remission with no treatment failures. In conclusion, a combination MMF-CSA protocol is an effective therapeutic alternative for induction of children with severe proliferative LN, resulting in significant clinical and serological improvement with minimal adverse effects.

• Authors: E Aragon, Y H Chan, K H Ng, Y W Lau, P H Tan, H K Yap
• Journal: Lupus (Lupus) Vol. 19 Issue 8 Pg. 965-73 (Jul 2010) ISSN: 1477-0962 [Electronic] England
• PMID: 20581019 (Publication Type: Clinical Trial, Journal Article)

Chemical References

• Immunosuppressive Agents
• Cyclosporine
• Mycophenolic Acid

Topics

• Adolescent
• Child
• Child, Preschool
• Cyclosporine (therapeutic use)
• Disease Progression
• Humans
• Immunosuppressive Agents (therapeutic use)
• Lupus Nephritis (drug therapy, pathology, physiopathology)
• Male
• Mycophenolic Acid (analogs & derivatives, therapeutic use)
• Remission Induction
• Retrospective Studies
• Treatment Outcome