Consensus treatment plans for induction therapy of newly diagnosed proliferative lupus nephritis in juvenile systemic lupus erythematosus
Consensus treatment plans for induction therapy of newly diagnosed proliferative lupus nephritis in juvenile systemic lupus erythematosus
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DOI：
10.1002/acr.21558
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发表时间：
2012-03-01
影响因子：
4.7
通讯作者：
Brunner, Hermine I.
中科院分区：
文献类型：
--
作者：
Mina, Rina;von Scheven, Emily;Brunner, Hermine I.
目的 制定青少年系统性红斑狼疮（SLE）初诊增生性狼疮肾炎（LN）诱导治疗的共识治疗计划（CTP）。方法。儿童关节炎和风湿病研究联盟的成员在考虑了现有的医学证据和当前的治疗方法后，采用了结构化的共识形成过程。结果。经过最初的 Delphi 调查（响应率 = 70%）、为期 2 天的共识会议和 2 次后续 Delphi 调查（响应率 = 63-79%），针对增殖性 LN 诱导治疗的有限 CTP 集达成了共识。这些 CTP 是针对根据资格特征定义的典型患者而开发的，包括每天两次口服麦考酚酸或每月一次以标准化剂量静脉注射环磷酰胺的免疫抑制治疗，持续 6 个月。此外，CTP 描述了糖皮质激素标准化使用的 3 种选择，包括主要口服、混合口服/静脉注射和主要静脉注射方案。就 CTP 的有效性和安全性措施达成了共识。 CTP 受到治疗 LN 儿童的儿科风湿病医生的广泛接受，预计北美每年有多达 300 名儿童成为 CTP 治疗的候选者。结论。基于现有的科学证据和儿科风湿病学小组的经验，已经开发出用于青少年 SLE 增殖性 LN 诱导治疗的 CTP。持续使用 CTP 可以改善增殖性 LN 的预后，并支持进行旨在优化青少年 SLE 增殖性 LN 治疗策略的比较有效性研究。
Objective To formulate consensus treatment plans (CTPs) for induction therapy of newly diagnosed proliferative lupus nephritis (LN) in juvenile systemic lupus erythematosus (SLE).Methods. A structured consensus formation process was employed by the members of the Childhood Arthritis and Rheumatology Research Alliance after considering the existing medical evidence and current treatment approaches.Results. After an initial Delphi survey ( response rate = 70%), a 2-day consensus conference, and 2 followup Delphi surveys ( response rates = 63-79%), consensus was achieved for a limited set of CTPs addressing the induction therapy of proliferative LN. These CTPs were developed for prototypical patients defined by eligibility characteristics, and included immunosuppressive therapy with either mycophenolic acid orally twice per day, or intravenous cyclophosphamide once per month at standardized dosages for 6 months. Additionally, the CTPs describe 3 options for standardized use of glucocorticoids, including a primarily oral, a mixed oral/intravenous, and a primarily intravenous regimen. There was consensus on measures of effectiveness and safety of the CTPs. The CTPs were well accepted by the pediatric rheumatology providers treating children with LN, and up to 300 children per year in North America are expected to be candidates for the treatment with the CTPs.Conclusion. CTPs for induction therapy of proliferative LN in juvenile SLE based on the available scientific evidence and pediatric rheumatology group experience have been developed. Consistent use of the CTPs may improve the prognosis of proliferative LN, and support the conduct of comparative effectiveness studies aimed at optimizing therapeutic strategies for proliferative LN in juvenile SLE.