Department of Internal Medicine, Inje University College of Medicine, South Korea.
Lupus. 2011 Nov;20(13):1442-9. doi: 10.1177/0961203311416034. Epub 2011 Sep 27.
Debate continues about the optimal treatment modality of lupus nephritis (LN). We compared the efficacy and safety of intravenous cyclophosphamide (CYC) and mycophenolate mofetil (MMF) for LN treatment in Korea. After searching for systemic lupus erythematosus (SLE) patients diagnosed between 1998 and 2007 with the diagnostic code of ICD10, we selected the 71 patients who were treated with CYC or MMF without any other immunosuppressant except systemic steroid. Composite outcome was defined as progression to end-stage renal disease (ESRD) and/or all-cause mortality. The initial manifestations of the CYC group were more severe than those of the MMF group. The mean daily MMF dose was 980 ± 100 mg for 21.67 ± 18.25 months. The mean monthly dose per CYC pulse therapy was 850 ± 30 mg for 17.04 ± 13.15 months. The incidence of composite outcome was 5/20 (25%) in the MMF group and 4/51 (7.8%) in the CYC group. The relative risk (RR) for composite outcome in the CYC group was 0.249 (95% CI for RR: 0.067-0.934, p = 0.039) compared with the MMF group with Cox's hazard proportional analysis. In Kaplan-Meier analysis, the probability of composite outcome was lower in the CYC group than in the MMF group (Log rank test p-value = 0.026). The results of this retrospective study suggest that intravenous CYC therapy may be more efficacious in averting ESRD and death than MMF. These results need to be confirmed in a larger randomized controlled trial.
关于狼疮肾炎 (LN) 的最佳治疗方式仍存在争议。我们比较了静脉注射环磷酰胺 (CYC) 和吗替麦考酚酯 (MMF) 在韩国治疗 LN 的疗效和安全性。通过搜索 1998 年至 2007 年间以 ICD10 诊断代码诊断为系统性红斑狼疮 (SLE) 的患者，我们选择了 71 例仅接受全身皮质类固醇治疗而未使用其他免疫抑制剂的 CYC 或 MMF 治疗患者。复合终点定义为进展为终末期肾病 (ESRD) 和/或全因死亡率。CYC 组的初始表现比 MMF 组更严重。MMF 组的平均日剂量为 980 ± 100mg，持续时间为 21.67 ± 18.25 个月。每个 CYC 脉冲治疗的平均每月剂量为 850 ± 30mg，持续时间为 17.04 ± 13.15 个月。MMF 组的复合终点发生率为 5/20（25%），CYC 组为 4/51（7.8%）。Cox 比例风险分析显示，与 MMF 组相比，CYC 组复合终点的相对风险（RR）为 0.249（95%CI RR：0.067-0.934，p=0.039）。在 Kaplan-Meier 分析中，CYC 组的复合终点发生率低于 MMF 组（Log rank 检验 p 值=0.026）。这项回顾性研究的结果表明，与 MMF 相比，静脉注射 CYC 治疗可能更能有效预防 ESRD 和死亡。这些结果需要在更大的随机对照试验中得到证实。
