Early response to immunosuppressive therapy predicts good renal outcome in lupus nephritis lessons from long-term followup of patients in the Euro-Lupus Nephritis Trial -: Lessons from long-term followup of patients in the Euro-Lupus Nephritis Trial
Early response to immunosuppressive therapy predicts good renal outcome in lupus nephritis lessons from long-term followup of patients in the Euro-Lupus Nephritis Trial -: Lessons from long-term followup of patients in the Euro-Lupus Nephritis Trial
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DOI：
10.1002/art.20666
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发表时间：
2004-12-01
影响因子：
--
通讯作者：
Cervera, R
中科院分区：
文献类型：
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作者：
Houssiau, FA;Vasconcelos, C;Cervera, R
Objective.在欧洲狼疮性肾炎试验（ELNT）中，90例狼疮性肾炎患者被随机分配到高剂量静脉环磷酰胺（IV CYC）方案（6个月脉冲和2个季度脉冲，剂量递增）或低剂量IV CYC方案（6个500 mg脉冲，间隔2周），随后分别使用硫唑嘌呤（AZA）。中位随访41个月后，未观察到两种方案之间的疗效差异。本分析旨在延长随访时间并确定预后因素。除5例失访外，每季度对所有90例患者的肾功能进行前瞻性评估。生存曲线采用Kaplan-Meier法。中位随访73个月后，接受低剂量IV CYC方案的患者与接受高剂量方案的患者在终末期肾病或血清肌酐水平加倍的累积概率方面无显著差异。在长期随访时，18例患者（8例接受低剂量治疗，10例接受高剂量治疗）发生了永久性肾损害，并被归类为长期肾脏结局不良。我们通过多变量分析证明，6个月时对治疗的早期反应（定义为血清肌酐水平和蛋白尿的降低）
Objective. In the Euro-Lupus Nephritis Trial (ELNT), 90 patients with lupus nephritis were randomly assigned to a high-dose intravenous cyclophosphamide (IV CYC) regimen (6 monthly pulses and 2 quarterly pulses with escalating doses) or a low-dose IV CYC regimen (6 pulses of 500 mg given at intervals of 2 weeks), each of which was followed by azathioprine (AZA). After a median followup of 41 months, a difference in efficacy between the 2 regimens was not observed. The present analysis was undertaken to extend the followup and to identify prognostic factors.Methods. Renal function was prospectively assessed quarterly in all 90 patients except 5 who were lost to followup. Survival curves were derived using the Kaplan-Meier method.Results. After a median followup of 73 months, there was no significant difference in the cumulative probability of end-stage renal disease or doubling of the serum creatinine level in patients who received the low-dose IV CYC regimen versus those who received the high-dose regimen. At long-term followup, 18 patients (8 receiving low-dose and 10 receiving high-dose treatment) had developed permanent renal impairment and were classified as having poor long-term renal outcome. We demonstrated by multivariate analysis that early response to therapy at 6 months (defined as a decrease in serum creatinine level and proteinuria