| Title | Combined immunosuppressive treatment (CIST) in lupus nephritis: a multicenter, randomized controlled study |
| Authors | An, Yuan Zhou, Yunshan Bi, Liqi Liu, Bo Wang, Hong Lin, Jin Xu, Danyi Wang, Mei Zhang, Jing Wang, Yongfu An, Yan Zhu, Ping Xie, Ronghua Zhang, Zhiyi Mei, Yifang Liu, Xiangyuan Deng, Xiaoli Yao, Zhongqiang Zhang, Zhuoli Wang, Yu Xiao, Weiguo Shen, Hui Yang, Xiuyan Xu, Hanshi Yu, Feng Wang, Guochun Lu, Xin Li, Yang Li, Yingnan Zuo, Xiaoxia Li, Yisha Liu, Yi Zhao, Yi Guo, Jianping Sun, Lingyun Zhao, Minghui Li, Zhanguo |
| Affiliation | Peking Univ, Peoples Hosp, Dept Rheumatol & Immunol, 11 Xizhimen South St, Beijing 100044, Peoples R China Jilin Univ, China Japan Union Hosp, Dept Rheumatol, Changchun, Jilin, Peoples R China Nanjing Univ, Med Sch, Affiliated Drum Tower Hosp, Dept Rheumatol & Immunol, Nanjing, Jiangsu, Peoples R China Zhejing Univ, Affiliated Hosp 1, Dept Rheumatol & Immunol, Hangzhou, Zhejiang, Peoples R China Peking Univ, Peoples Hosp, Dept Nephrol, Beijing, Peoples R China Baotou Med Coll, Affiliated Hosp 1, Dept Rheumatol, Baotou, Peoples R China Fourth Mil Med Univ, Xijing Hosp, Dept Clin Immunol, Xian, Shaanxi, Peoples R China Harbin Med Univ, Affiliated Hosp 1, Dept Rheumatol & Immunol, Harbin, Heilongjiang, Peoples R China Peking Univ, Hosp 3, Dept Rheumatol & Immunol, Beijing, Peoples R China Peking Univ, Hosp 1, Dept Rheumatol & Immunol, Beijing, Peoples R China China Med Univ, Affiliated Hosp 1, Dept Rheumatol & Immunol, Shenyang, Liaoning, Peoples R China Sun Yat Sen Univ, Affiliated Hosp 1, Dept Rheumatol, Guangzhou, Guangdong, Peoples R China Peking Univ, Hosp 1, Dept Nephrol, Beijing, Peoples R China China Japan Friendship Hosp, Dept Rheumatol & Immunol, Beijing, Peoples R China Harbin Med Univ, Clin Hosp 2, Dept Rheumatol & Immunol, Harbin, Heilongjiang, Peoples R China Cent S Univ, Xiangya Hosp, Dept Rheumatol & Immunol, Changsha, Hunan, Peoples R China Sichuan Univ, West China Hosp, Dept Rheumatol & Immunol, Chengdu, Sichuan, Peoples R China |
| Keywords | Immunosuppressive agents Lupus nephritis Remission inducing Systemic lupus erythematosus |
| Issue Date | 2019 |
| Publisher | CLINICAL RHEUMATOLOGY |
| Abstract | ObjectivesThe standard strategy for treating lupus nephritis comprises glucocorticoids together with either intravenous cyclophosphamide or oral mycophenolate mofetil, but the low remission rate is still a challenge in practice. This study was aimed to seek higher remission rate of lupus nephritis using a combined strategy.MethodA 24-week trial was conducted in 17 rheumatology or nephrology centers in China. A total of 191 lupus nephritis patients were randomized to follow a combined immunosuppressive treatment (CIST) with intravenous cyclophosphamide, an oral immunosuppressive agent, namely mycophenolate mofetil, azathioprine or leflunomide, and hydroxychloroquine (n=95), or receive intravenous cyclophosphamide alone (n=96) for 24weeks. Glucocorticoid was given to both groups. The primary end point was a complete remission with a most stringent standard as proteinuria <150mg per 24h, normal urinary sediment, serum albumin, and renal function at 24weeks. The secondary end point was treatment failure at 24weeks.ResultsAt week 24, both the rate of complete remission (39.5%) and total response (87.2%) was higher in the combined group, compared with CYC group (20.8% and 68.8%, p<0.05). The cumulative probability of complete remission was also higher in the combined group (p=0.013). In addition, the combined treatment was superior to routine CYC with less treatment failure (12.8% vs.31.2%, p<0.001). No difference was found between the incidences of severe adverse events in the two arms: 3.2% (3/95 combined group) vs.4.2% (4/96 CYC group).ConclusionTreatment with a combined immunosuppressive agent is superior to routine CYC only therapy in lupus nephritis. |
| URI | http://hdl.handle.net/20.500.11897/549623 |
| ISSN | 0770-3198 |
| DOI | 10.1007/s10067-018-4368-8 |
| Indexed | SCI(E) |
| Appears in Collections: | 人民医院 第三医院 第一医院 |
