High plasma mycophenolate acid concentration in the early phase of induction therapy predicts good renal outcome in lupus nephritis
High plasma mycophenolate acid concentration in the early phase of induction therapy predicts good renal outcome in lupus nephritis
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DOI：
10.1080/14397595.2019.1623435
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发表时间：
2019-06-11
影响因子：
2.2
通讯作者：
Kawahata, Kimito
中科院分区：
文献类型：
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作者：
Kiyokawa, Tomofumi;Hanaoka, Hironari;Kawahata, Kimito
目的：通过关注狼疮性肾炎诱导治疗中的血浆霉酚酸 (MPA) 浓度，确定第 12 周完全肾缓解 (CR) 的预后预测因素。方法：我们前瞻性地纳入了 2016 年至 2017 年间住院的经活检证实为 III/IV 级 LN 的患者。作为诱导治疗，持续引入吗替麦考酚酯，剂量为 2000 mg/天。我们在两个时间点测量了 MPA 血浆浓度，具体取决于诱导治疗阶段：早期（第 4 周）或中期（第 12 周）。评估了第 12 周时这些浓度与 CR 率之间的关联。结果：10 名患者入组。在第 12 周达到 CR 的患者中观察到早期 MPA 0 至 12 小时之间的 AUC(0-12) 显着高于未达到 CR 的患者 (p = .03)。所有早期MPA-AUC(0-12)(>40mg·h/L)较高的患者均在第12周达到CR，但中期未发现这种关联。多变量分析显示，MPA-AUC0-12 被选为第 12 周 CR 的独立预测因素（比值比：1.12；95% 置信区间：1.01-1.45，p = .02）。结论：诱导治疗早期MPA的高AUC（0-12）可能预示着良好的肾反应。
Objectives: To identify the prognostic predictive factor of complete renal response (CR) at week 12 by focusing on the plasma mycophenolic acid (MPA) concentration in induction therapy in lupus nephritis. Methods: We prospectively enrolled patients with biopsy-proven LN class III/IV who were hospitalized between 2016 and 2017. As an induction therapy, mycophenolate mofetil was continuously introduced at 2000 mg/day. We measured the MPA plasma concentration at two time points depending on the induction therapy phase, early (week 4) or middle (week 12). The association between these concentrations and CR rate at week 12 was evaluated. Results: Ten patients were enrolled. A significantly higher AUC(0-12) between 0 and 12 h of MPA at the early phase was observed in the patients with CR at week 12 than in those without (p = .03). All the patients with high MPA-AUC(0-12) (> 40 mg h/L) at the early phase achieved CR at week 12, but no such association was found at the middle phase. The multivariate analysis revealed that MPA-AUC0-12 was selected as an independent predictive factor of CR at week 12 (odds ratio: 1.12; 95% confidence interval: 1.01-1.45, p = .02). Conclusion: The high AUC(0-12) of MPA at the early phase of induction therapy may predict good renal response.