Crossing the Atlantic: the Euro-Lupus Nephritis regimen in North America.
Crossing the Atlantic: the Euro-Lupus Nephritis regimen in North America.
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DOI：
10.1002/art.39067
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发表时间：
2015-05
期刊：
影响因子：
--
通讯作者：
Houssiau FA
中科院分区：
文献类型：
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作者：
Wofsy D;Diamond B;Houssiau FA
More than a quarter century has passed since a landmark trial at the National Institutes of Health (NIH) established pulse intravenous cyclophosphamide (IVC) and high-dose glucocorticoids as the standard of care for active lupus nephritis (1). In the ensuing years, numerous other conventional and biologic therapies have been proposed and tested, most notably mycophenolate mofetil (MMF)(2) and rituximab (3), but none has been demonstrated to be superior to IVC during induction treatment of active disease.Until new therapeutic strategies emerge that are proven superior to IVC, there will be a need for evidence-based best practices to guide the use of cyclophosphamide. For this reason, the Euro-Lupus Nephritis Trial (ELNT) compared two approaches to IVC treatment. One approach consisted of 44 weeks of IVC based on the NIH regimen, followed by maintenance therapy with azathioprine (AZA). The other approach consisted of just six biweekly infusions of IVC at lower doses (500 mg/infusion), followed by maintenance therapy with AZA (4, 5). After 10 years of follow-up, efficacy was comparable in the two groups; the frequency of serious infectious complications was lower in the low-dose IVC group, but this advantage did not reach statistical significance. Despite the ELNT results, many lupus experts have been hesitant to adopt the modified regimen, citing concerns that the findings in a population of northern European, primarily Caucasian subjects might not be generalizable to other populations that tend to have more severe and refractory nephritis (eg, Black and Hispanic patients).
