突尼斯增殖性狼疮肾炎患者在三种不同诱导免疫抑制剂作用下的肾脏反应评估:预后回顾性研究。

IF 1.9 4区 医学 Q3 RHEUMATOLOGY Lupus Pub Date : 2024-10-03 DOI:10.1177/09612033241289479
Mehdi Somai, Fatma Daoud, Ibrahim Arbaoui, Rihem Boukhzar, Besma Ben Dhaou, Hedia Bellali, Fatma Boussema, Imene Rachdi, Zohra Aydi
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引用次数: 0

摘要

研究目的我们的研究旨在评估突尼斯人群在增殖性狼疮肾炎(PLN)诱导治疗中三种免疫抑制方案的肾脏反应(RR):2000年1月至2023年12月,我们在突尼斯哈比卜-塔梅尔大学医院内科进行了一项回顾性预后队列研究,纳入了经肾活检证实的增殖性狼疮肾炎患者。比较了三种诱导治疗方法:高CYP方案:糖皮质激素(GC)+静脉注射环磷酰胺(CYP),每月一次,每次0.7克/平方米,持续6个月;低CYP方案:糖皮质激素(GC)+静脉注射环磷酰胺(CYP),每两周一次,每次 500 毫克,持续 3 个月;以及 MMF 方案:GC + 口服 MMF 1.5 克,每日两次,为期 6 个月。主要终点是确诊后一年的 RR(完全缓解和部分缓解)发生率。其他结果为终末期肾病(ESKD)、严重不良事件(AEs)和死亡:我们的研究包括 78 名 PLN 患者(高 CYP:17 人,低 CYP:40 人,MMF:21 人)。研究发现,94.1%的高CYP患者达到了主要终点RR,而低CYP患者为67.5%,MMF组为61.9%。在其他结果中,有3例ESKD,全部发生在低CYP组;5例死亡(低CYP组4例,MMF组1例);20例严重AE,全部为严重感染(高CYP组5例,低CYP组12例,MMF组3例)。多变量分析显示,高 CYP 方案比 MMF 方案与 RR 更相关,调整 OR 为 9.846(95% CI:1.087-98.210);P = 0.042。多变量分析显示,高CYP方案与低CYP方案在RR方面的差异无统计学意义:结论:作为 PLN 的诱导治疗方案,高 CYP 方案比 MMF 方案与更高的 RR 率密切相关。高CYP方案与低CYP方案在RR方面没有统计学差异。
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Assessment of renal response in Tunisian patients with proliferative lupus nephritis under three different induction immunosuppressive agents: A prognostic retrospective study.

Objective: The aim of our study was to evaluate the renal response (RR) of three immunosuppressive protocols in the induction treatment of proliferative lupus nephritis (PLN) in a Tunisian population.

Methods: We performed a retrospective prognostic cohort study in the Internal Medicine Department of the Habib Thameur University Hospital in Tunis from January 2000 to December 2023, and included kidney biopsy proven proliferative lupus nephritis patients. Three induction treatments were compared: High CYP regimen: glucocorticoids (GC) + IV cyclophosphamide (CYP) in monthly pulses of 0.7 g/m2 for 6 months; Low CYP regimen: GC + IV CYP in biweekly pulses of 500 mg for 3 months; and MMF regimen: GC + oral MMF 1.5 g twice daily for 6 months. The primary endpoint was the incidence of RR (complete and partial remission) at one year post-diagnosis. The additional outcomes were end-stage kidney disease (ESKD), severe adverse events (AEs) and death.

Results: Our study included 78 PLN patients (High CYP: 17, Low CYP: 40, MMF: 21). The study found that 94.1% of patients receiving High CYP achieved the primary endpoint, RR, compared to 67.5% of those receiving Low CYP and 61.9% in the MMF group. For the additional outcomes, there were 3 cases of ESKD, all in the Low CYP group, 5 cases of death (4 in the Low CYP group and 1 in the MMF group), and 20 cases of severe AEs, all of which were severe infections (5 in the High CYP group, 12 in the Low CYP group, and 3 in the MMF group). Multivariate analysis showed that the High CYP regimen was more associated with RR than the MMF regimen, with an adjusted OR of 9.846 (95% CI: 1.087-98.210); p = 0.042. Multivariate analysis did not show statistically significant differences between the High CYP regimen and the Low CYP regimen in terms of RR.

Conclusion: As an induction treatment for PLN, the High CYP regimen was strongly associated with a higher rate of RR than the MMF regimen. There were no statistically significant differences between the High CYP regimen and the Low CYP regimen in terms of RR.

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来源期刊
Lupus
Lupus 医学-风湿病学
CiteScore
4.20
自引率
11.50%
发文量
225
审稿时长
1 months
期刊介绍: The only fully peer reviewed international journal devoted exclusively to lupus (and related disease) research. Lupus includes the most promising new clinical and laboratory-based studies from leading specialists in all lupus-related disciplines. Invaluable reading, with extended coverage, lupus-related disciplines include: Rheumatology, Dermatology, Immunology, Obstetrics, Psychiatry and Cardiovascular Research…
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