File Download
 
Links for fulltext
(May Require Subscription)
 
Supplementary

Article: Long-term outcome of diffuse proliferative lupus glomerulonephritis treated with cyclophosphamide
  • Basic View
  • Metadata View
  • XML View
TitleLong-term outcome of diffuse proliferative lupus glomerulonephritis treated with cyclophosphamide
 
AuthorsMok, CC2
Ying, KY1
Ng, WL4
Lee, KW3
To, CH2
Lau, CS5
Wong, RWS5
Au, TC2
 
Issue Date2006
 
PublisherExcerpta Medica, Inc. The Journal's web site is located at http://www.elsevier.com/locate/amj
 
CitationAmerican Journal Of Medicine, 2006, v. 119 n. 4, p. 355.e25-355.e33 [How to Cite?]
DOI: http://dx.doi.org/10.1016/j.amjmed.2005.08.045
 
AbstractPURPOSE: To report the long-term outcome of diffuse proliferative lupus nephritis (DPLN) treated with cyclophosphamide (CYC) in Chinese patients. METHODS: Patients with biopsy-proven DPLN treated with prednisolone and CYC were identified. The long-term renal outcome and treatment-related toxicities were reported. RESULTS: A total of 212 patients were studied (89% women; mean age 30.9 ± 10.9 years; mean system lupus erythematosus [SLE] duration 36.7 ± 55.1 months). At renal biopsy, 148 (70%) patients were nephrotic, and 78 (37%) had impaired serum creatinine. One hundred and three (49%) patients received daily oral CYC, whereas 109 (51%) received intravenous bolus CYC. At last dose of CYC, 126 (59%) patients responded completely, and 56 (26%) responded partially. In a logistic regression model, the cumulative CYC dose and histologic chronicity score predicted complete response. One hundred fifty-five (73%) patients received maintenance immunosuppression for at least 3 years (88% azathioprine). After a follow-up of 1873 patient-years, 66 patients experienced renal flares, 30 had doubling of serum creatinine, 18 developed end-stage renal failure, and 14 died. The renal survival rates were 88.7%, 82.8% and 70.7% at 5, 10 and 15 years, respectively. Failure to respond completely to CYC and the absence of maintenance immunosuppression were independent predictors of a poor renal outcome. Ovarian toxicity was more frequent with the oral CYC regimen. Increasing age and higher cumulative doses of CYC were independent risk factors. CONCLUSIONS: In Chinese patients with DPLN, the cumulative dose, rather than the route of CYC administration, determines the initial treatment response and ovarian toxicity. Maintenance immunosuppression is associated with a better long-term prognosis. The oral CYC regimen is more toxic and should be reserved for high-risk patients. © 2006 Elsevier Inc. All rights reserved.
 
ISSN0002-9343
2012 Impact Factor: 4.768
2012 SCImago Journal Rankings: 1.676
 
DOIhttp://dx.doi.org/10.1016/j.amjmed.2005.08.045
 
ReferencesReferences in Scopus
 
DC FieldValue
dc.contributor.authorMok, CC
 
dc.contributor.authorYing, KY
 
dc.contributor.authorNg, WL
 
dc.contributor.authorLee, KW
 
dc.contributor.authorTo, CH
 
dc.contributor.authorLau, CS
 
dc.contributor.authorWong, RWS
 
dc.contributor.authorAu, TC
 
dc.date.accessioned2012-09-05T05:25:50Z
 
dc.date.available2012-09-05T05:25:50Z
 
dc.date.issued2006
 
dc.description.abstractPURPOSE: To report the long-term outcome of diffuse proliferative lupus nephritis (DPLN) treated with cyclophosphamide (CYC) in Chinese patients. METHODS: Patients with biopsy-proven DPLN treated with prednisolone and CYC were identified. The long-term renal outcome and treatment-related toxicities were reported. RESULTS: A total of 212 patients were studied (89% women; mean age 30.9 ± 10.9 years; mean system lupus erythematosus [SLE] duration 36.7 ± 55.1 months). At renal biopsy, 148 (70%) patients were nephrotic, and 78 (37%) had impaired serum creatinine. One hundred and three (49%) patients received daily oral CYC, whereas 109 (51%) received intravenous bolus CYC. At last dose of CYC, 126 (59%) patients responded completely, and 56 (26%) responded partially. In a logistic regression model, the cumulative CYC dose and histologic chronicity score predicted complete response. One hundred fifty-five (73%) patients received maintenance immunosuppression for at least 3 years (88% azathioprine). After a follow-up of 1873 patient-years, 66 patients experienced renal flares, 30 had doubling of serum creatinine, 18 developed end-stage renal failure, and 14 died. The renal survival rates were 88.7%, 82.8% and 70.7% at 5, 10 and 15 years, respectively. Failure to respond completely to CYC and the absence of maintenance immunosuppression were independent predictors of a poor renal outcome. Ovarian toxicity was more frequent with the oral CYC regimen. Increasing age and higher cumulative doses of CYC were independent risk factors. CONCLUSIONS: In Chinese patients with DPLN, the cumulative dose, rather than the route of CYC administration, determines the initial treatment response and ovarian toxicity. Maintenance immunosuppression is associated with a better long-term prognosis. The oral CYC regimen is more toxic and should be reserved for high-risk patients. © 2006 Elsevier Inc. All rights reserved.
 
dc.description.natureLink_to_subscribed_fulltext
 
dc.identifier.citationAmerican Journal Of Medicine, 2006, v. 119 n. 4, p. 355.e25-355.e33 [How to Cite?]
DOI: http://dx.doi.org/10.1016/j.amjmed.2005.08.045
 
dc.identifier.doihttp://dx.doi.org/10.1016/j.amjmed.2005.08.045
 
dc.identifier.epage355.e33
 
dc.identifier.issn0002-9343
2012 Impact Factor: 4.768
2012 SCImago Journal Rankings: 1.676
 
dc.identifier.issue4
 
dc.identifier.pmid16564783
 
dc.identifier.scopuseid_2-s2.0-33645241849
 
dc.identifier.spage355.e25
 
dc.identifier.urihttp://hdl.handle.net/10722/162954
 
dc.identifier.volume119
 
dc.languageeng
 
dc.publisherExcerpta Medica, Inc. The Journal's web site is located at http://www.elsevier.com/locate/amj
 
dc.publisher.placeUnited States
 
dc.relation.ispartofAmerican Journal of Medicine
 
dc.relation.referencesReferences in Scopus
 
dc.subject.meshAdministration, Oral
 
dc.subject.meshAdult
 
dc.subject.meshAmenorrhea - Chemically Induced
 
dc.subject.meshAnalysis Of Variance
 
dc.subject.meshAnti-Inflammatory Agents - Therapeutic Use
 
dc.subject.meshChina
 
dc.subject.meshCyclophosphamide - Administration & Dosage - Adverse Effects
 
dc.subject.meshDrug Therapy, Combination
 
dc.subject.meshFemale
 
dc.subject.meshHumans
 
dc.subject.meshImmunosuppressive Agents - Administration & Dosage - Adverse Effects
 
dc.subject.meshInjections, Intravenous
 
dc.subject.meshLogistic Models
 
dc.subject.meshLupus Nephritis - Drug Therapy - Pathology
 
dc.subject.meshMale
 
dc.subject.meshOvary - Drug Effects
 
dc.subject.meshPrednisolone - Therapeutic Use
 
dc.subject.meshPrognosis
 
dc.subject.meshRetrospective Studies
 
dc.subject.meshRisk Assessment
 
dc.subject.meshRisk Factors
 
dc.subject.meshTime Factors
 
dc.subject.meshTreatment Failure
 
dc.subject.meshTreatment Outcome
 
dc.titleLong-term outcome of diffuse proliferative lupus glomerulonephritis treated with cyclophosphamide
 
dc.typeArticle
 
<?xml encoding="utf-8" version="1.0"?>
<item><contributor.author>Mok, CC</contributor.author>
<contributor.author>Ying, KY</contributor.author>
<contributor.author>Ng, WL</contributor.author>
<contributor.author>Lee, KW</contributor.author>
<contributor.author>To, CH</contributor.author>
<contributor.author>Lau, CS</contributor.author>
<contributor.author>Wong, RWS</contributor.author>
<contributor.author>Au, TC</contributor.author>
<date.accessioned>2012-09-05T05:25:50Z</date.accessioned>
<date.available>2012-09-05T05:25:50Z</date.available>
<date.issued>2006</date.issued>
<identifier.citation>American Journal Of Medicine, 2006, v. 119 n. 4, p. 355.e25-355.e33</identifier.citation>
<identifier.issn>0002-9343</identifier.issn>
<identifier.uri>http://hdl.handle.net/10722/162954</identifier.uri>
<description.abstract>PURPOSE: To report the long-term outcome of diffuse proliferative lupus nephritis (DPLN) treated with cyclophosphamide (CYC) in Chinese patients. METHODS: Patients with biopsy-proven DPLN treated with prednisolone and CYC were identified. The long-term renal outcome and treatment-related toxicities were reported. RESULTS: A total of 212 patients were studied (89% women; mean age 30.9 &#177; 10.9 years; mean system lupus erythematosus [SLE] duration 36.7 &#177; 55.1 months). At renal biopsy, 148 (70%) patients were nephrotic, and 78 (37%) had impaired serum creatinine. One hundred and three (49%) patients received daily oral CYC, whereas 109 (51%) received intravenous bolus CYC. At last dose of CYC, 126 (59%) patients responded completely, and 56 (26%) responded partially. In a logistic regression model, the cumulative CYC dose and histologic chronicity score predicted complete response. One hundred fifty-five (73%) patients received maintenance immunosuppression for at least 3 years (88% azathioprine). After a follow-up of 1873 patient-years, 66 patients experienced renal flares, 30 had doubling of serum creatinine, 18 developed end-stage renal failure, and 14 died. The renal survival rates were 88.7%, 82.8% and 70.7% at 5, 10 and 15 years, respectively. Failure to respond completely to CYC and the absence of maintenance immunosuppression were independent predictors of a poor renal outcome. Ovarian toxicity was more frequent with the oral CYC regimen. Increasing age and higher cumulative doses of CYC were independent risk factors. CONCLUSIONS: In Chinese patients with DPLN, the cumulative dose, rather than the route of CYC administration, determines the initial treatment response and ovarian toxicity. Maintenance immunosuppression is associated with a better long-term prognosis. The oral CYC regimen is more toxic and should be reserved for high-risk patients. &#169; 2006 Elsevier Inc. All rights reserved.</description.abstract>
<language>eng</language>
<publisher>Excerpta Medica, Inc. The Journal&apos;s web site is located at http://www.elsevier.com/locate/amj</publisher>
<relation.ispartof>American Journal of Medicine</relation.ispartof>
<subject.mesh>Administration, Oral</subject.mesh>
<subject.mesh>Adult</subject.mesh>
<subject.mesh>Amenorrhea - Chemically Induced</subject.mesh>
<subject.mesh>Analysis Of Variance</subject.mesh>
<subject.mesh>Anti-Inflammatory Agents - Therapeutic Use</subject.mesh>
<subject.mesh>China</subject.mesh>
<subject.mesh>Cyclophosphamide - Administration &amp; Dosage - Adverse Effects</subject.mesh>
<subject.mesh>Drug Therapy, Combination</subject.mesh>
<subject.mesh>Female</subject.mesh>
<subject.mesh>Humans</subject.mesh>
<subject.mesh>Immunosuppressive Agents - Administration &amp; Dosage - Adverse Effects</subject.mesh>
<subject.mesh>Injections, Intravenous</subject.mesh>
<subject.mesh>Logistic Models</subject.mesh>
<subject.mesh>Lupus Nephritis - Drug Therapy - Pathology</subject.mesh>
<subject.mesh>Male</subject.mesh>
<subject.mesh>Ovary - Drug Effects</subject.mesh>
<subject.mesh>Prednisolone - Therapeutic Use</subject.mesh>
<subject.mesh>Prognosis</subject.mesh>
<subject.mesh>Retrospective Studies</subject.mesh>
<subject.mesh>Risk Assessment</subject.mesh>
<subject.mesh>Risk Factors</subject.mesh>
<subject.mesh>Time Factors</subject.mesh>
<subject.mesh>Treatment Failure</subject.mesh>
<subject.mesh>Treatment Outcome</subject.mesh>
<title>Long-term outcome of diffuse proliferative lupus glomerulonephritis treated with cyclophosphamide</title>
<type>Article</type>
<description.nature>Link_to_subscribed_fulltext</description.nature>
<identifier.doi>10.1016/j.amjmed.2005.08.045</identifier.doi>
<identifier.pmid>16564783</identifier.pmid>
<identifier.scopus>eid_2-s2.0-33645241849</identifier.scopus>
<relation.references>http://www.scopus.com/mlt/select.url?eid=2-s2.0-33645241849&amp;selection=ref&amp;src=s&amp;origin=recordpage</relation.references>
<identifier.volume>119</identifier.volume>
<identifier.issue>4</identifier.issue>
<identifier.spage>355.e25</identifier.spage>
<identifier.epage>355.e33</identifier.epage>
<publisher.place>United States</publisher.place>
</item>
Author Affiliations
  1. Princess Margaret Hospital Hong Kong
  2. Tuen Mun Hospital
  3. Pamela Youde Nethersole Eastern Hospital
  4. United Christian Hospital Hong Kong
  5. Queen Mary Hospital Hong Kong