Long-term follow-up of a randomised controlled trial of azathioprine/methylprednisolone versus cyclophosphamide in patients with proliferative lupus nephritis

被引:47
|
作者
Arends, Suzanne [1 ]
Grootscholten, Cecile [2 ]
Derksen, Ronald H. W. M. [3 ]
Berger, Stefan P. [4 ]
de Sevaux, Ruud G. L. [5 ]
Voskuyl, Alexandre E. [6 ]
Bijl, Marc [1 ]
Berden, Jo H. M. [5 ]
机构
[1] Univ Groningen, Univ Med Ctr Groningen, Dept Rheumatol & Clin Immunol, NL-9700 RB Groningen, Netherlands
[2] Kennemer Gasthuis, Dept Internal Med, Haarlem, Netherlands
[3] Univ Med Ctr Utrecht, Dept Rheumatol & Clin Immunol, Utrecht, Netherlands
[4] Univ Med Ctr, Erasmus MC, Dept Internal Med, Rotterdam, Netherlands
[5] Radboud Univ Nijmegen, Med Ctr, Dept Nephrol, NL-6525 ED Nijmegen, Netherlands
[6] Vrije Univ Amsterdam Med Ctr, Dept Rheumatol, Amsterdam, Netherlands
关键词
AZATHIOPRINE PLUS METHYLPREDNISOLONE; MYCOPHENOLATE-MOFETIL; ORAL CYCLOPHOSPHAMIDE; GLOMERULONEPHRITIS; ERYTHEMATOSUS; PREDICTORS; PREDNISONE; OUTCOMES; THERAPY;
D O I
10.1136/annrheumdis-2011-200384
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objectives The objectives of this study are to analyse the long-term follow-up of a randomised controlled trial of induction treatment with azathioprine/methylprednisolone (AZA/MP) versus high-dose intravenous cyclophosphamide (ivCY) in patients with proliferative lupus nephritis (LN) and to evaluate the predictive value of clinical, laboratory and renal biopsy parameters regarding renal outcome. Methods 87 patients with biopsy-proven proliferative LN were treated with either AZA/MP (n=37) or ivCY (n=50), both with oral prednisone. After 2 years, renal biopsy was repeated, and all patients continued with AZA/oral prednisone. The primary study end point was sustained doubling of serum creatinine. Secondary end points included renal relapse, end-stage renal disease and mortality. Results After a median follow-up of 9.6 years, no significant differences between AZA/MP versus ivCY groups were found in the proportion of patients with sustained doubling of serum creatinine (n=6 (16%) vs n=4 (8%); p=0.313), end-stage renal disease (n=2 (5%) vs n=2 (4%); p=1.000) or mortality (n=6 (16%) vs n=5 (10%); p=0.388). Renal relapses occurred more often in the AZA/MP group (n=14 (38%) vs n=5 (10%); p=0.002, HR: 4.5). Serum creatinine, proteinuria and immunosuppressive treatment regimens at the last follow-up were comparable. Clinical and laboratory parameters at baseline and after 2 years, and renal biopsy parameters (only) at baseline predicted renal outcome. Conclusion Induction treatment with ivCY was superior to AZA/MP in preventing renal relapses, but other parameters for renal function did not differ. AZA/MP can therefore serve as an alternative in patients with proliferative LN who wish to avoid gonadal toxicity of CY. Several prognostic factors of long-term renal outcome were identified.
引用
收藏
页码:966 / 973
页数:8
相关论文
共 50 条
  • [41] LONG-TERM FOLLOW-UP OF LUPUS NEPHRITIS (LN) CLASSIFIED BY WHO HISTOLOGIC CRITERIA
    APPEL, GB
    ESTES, D
    COHEN, D
    MELTZER, J
    PIRANI, CL
    KIDNEY INTERNATIONAL, 1983, 23 (01) : 116 - 116
  • [42] WEGENERS GRANULOMATOSIS - LONG-TERM FOLLOW-UP OF PATIENTS TREATED WITH CYCLOPHOSPHAMIDE
    PEARSON, CM
    REZA, MJ
    BLUESTONE, R
    SCANDINAVIAN JOURNAL OF RHEUMATOLOGY, 1975, 4 : 905 - 905
  • [43] A Long-Term follow-up Study of Lupus Nephritis in a Single Tertiary Care Centre
    Rathoon, Ajay, I
    Gurusamy, Venu
    Ganesan, Vasanth
    Arivazhagan, S.
    Yaswanth, Chelikani
    INDIAN JOURNAL OF NEPHROLOGY, 2022, 32 (06) : 595 - 599
  • [44] Long-Term Follow-Up of Intratympanic Methylprednisolone Versus Gentamicin in Patients With Unilateral Meniere's Disease
    Harcourt, Jonny Philip
    Lambert, Aileen
    Wong, Phui Yee
    Patel, Mitesh
    Agarwal, Kiran
    Golding, John Foster
    Bronstein, Adolfo Miguel
    OTOLOGY & NEUROTOLOGY, 2019, 40 (04) : 491 - 496
  • [45] No mesh versus mesh in the treatment of anterior vaginal wall prolapse: prospective, randomised, controlled trial, long-term follow-up
    Nunes Tamanini, Jose Tadeu
    Reis, Leonardo Oliveira
    da Mota Tamanini, Mirce Milhomem
    Castro, Rodrigo Aquino
    Ferreira Sartori, Marair Gracio
    Batista Castello Girao, Manoel Joao
    INTERNATIONAL UROLOGY AND NEPHROLOGY, 2020, 52 (10) : 1839 - 1844
  • [46] No mesh versus mesh in the treatment of anterior vaginal wall prolapse: prospective, randomised, controlled trial, long-term follow-up
    José Tadeu Nunes Tamanini
    Leonardo Oliveira Reis
    Mirce Milhomem da Mota Tamanini
    Rodrigo Aquino Castro
    Marair Gracio Ferreira Sartori
    Manoel João Batista Castello Girão
    International Urology and Nephrology, 2020, 52 : 1839 - 1844
  • [47] Two years of adjuvant tamoxifen in premenopausal patients with breast cancer:: a randomised, controlled trial with long-term follow-up
    Rydén, L
    Jönsson, PE
    Chebil, G
    Dufmats, M
    Fernö, M
    Jirström, K
    Källström, AC
    Landberg, G
    Stål, O
    Thorstenson, S
    Nordenskjöld, B
    EUROPEAN JOURNAL OF CANCER, 2005, 41 (02) : 256 - 264
  • [48] LUPUS NEPHRITIS: LONG TERM FOLLOW-UP AND EFFECT OF TREATMENT ON GROWTH
    Topaloglu, Rezan
    Tas, Nesrin
    Celegen, Kubra
    Ozdemir, Gulsah
    Gulhan, Bora
    Duzova, Ali
    Ozaltin, Fatih
    Orhan, Diclehan
    PEDIATRIC NEPHROLOGY, 2018, 33 (10) : 1947 - 1947
  • [49] Long-term effects of antenatal exposure to betamethasone: Thirty year follow-up of a randomised controlled trial
    Dalziel, SR
    Walker, NK
    Parag, V
    Mantell, C
    Rea, HH
    Rodgers, A
    Harding, JE
    PEDIATRIC RESEARCH, 2004, 55 (04) : 372A - 372A
  • [50] Feasibility of personalised remote long-term follow-up of people with cochlear implants: a randomised controlled trial
    Cullington, Helen
    Kitterick, Padraig
    Weal, Mark
    Margol-Gromada, Magdalena
    BMJ OPEN, 2018, 8 (04):