Article: Long-term outcome of diffuse proliferative lupus glomerulonephritis treated with cyclophosphamide

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TitleLong-term outcome of diffuse proliferative lupus glomerulonephritis treated with cyclophosphamide
AuthorsMok, CC1
Ying, KY2
Ng, WL4
Lee, KW3
To, CH1
Lau, CS5
Wong, RWS5
Au, TC1
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
2011 Impact Factor: 5.43
2011 SCImago Journal Rankings: 0.364
DOIhttp://dx.doi.org/10.1016/j.amjmed.2005.08.045
ReferencesReferences in Scopus
DC Field
Value
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
2011 Impact Factor: 5.43
2011 SCImago Journal Rankings: 0.364
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
Author Affiliations
  1. Tuen Mun Hospital
  2. Princess Margaret Hospital Hong Kong
  3. Pamela Youde Nethersole Eastern Hospital
  4. United Christian Hospital Hong Kong
  5. Queen Mary Hospital Hong Kong