Tanaka H, Aizawa T, Watanabe S, Oki E, Tsuruga K, Imaizumi T
Department of Pediatrics, Hirosaki University Hospital Department of School Health Science, Faculty of Education, Hirosaki University
Department of Pediatrics, Hirosaki University Hospital.
Lupus. 2014 Jul;23(8):813-8. doi: 10.1177/0961203314528553. Epub 2014 Mar 20.
Recent advances in the management of lupus nephritis (LN) have also contributed to a favorable outcome in patients with pediatric-onset LN. Nevertheless, we believe that a more effective and less toxic treatment is needed to attain optimal control of pediatric-onset LN.
Seven consecutive children with biopsy-proven LN (four with class III/IV and three with class V) received multitarget induction therapy consisting of mizoribine (MZR), tacrolimus (Tac), and prednisolone (PDN). They were prospectively evaluated at three, six, and 12 months, and at the latest observation point after a mean period of 32 months. Post-treatment renal biopsy was performed in two patients with class III/IV.
Despite gradually tapering the dose of concomitantly administered PDN, a significant improvement compared with baseline values was observed in the urinary, serological, and clinical assessment measures even at three months of treatment, and the favorable changes persisted throughout the treatment period in most of the study participants except for one. In two patients who underwent post-treatment renal biopsy, a marked histologic improvement was confirmed. No serious adverse events were observed.
Multitarget therapy may be an attractive option for the treatment of pediatric-onset LN. Further studies involving a larger number of patients are needed.
狼疮性肾炎（LN）治疗的最新进展也促使儿童期发病的LN患者获得了良好的治疗效果。然而，我们认为需要一种更有效且毒性更小的治疗方法来实现对儿童期发病LN的最佳控制。
连续7例经活检证实为LN的儿童（4例为III/IV级，3例为V级）接受了由咪唑立宾（MZR）、他克莫司（Tac）和泼尼松龙（PDN）组成的多靶点诱导治疗。在3个月、6个月和12个月时以及平均32个月后的最新观察点对他们进行前瞻性评估。对2例III/IV级患者进行了治疗后肾活检。
尽管逐渐减少同时使用的PDN剂量，但即使在治疗3个月时，在尿液、血清学和临床评估指标方面与基线值相比仍有显著改善，并且除1例患者外，大多数研究参与者在整个治疗期间这些良好变化持续存在。在2例接受治疗后肾活检的患者中，证实有明显的组织学改善。未观察到严重不良事件。
多靶点治疗可能是治疗儿童期发病LN的一个有吸引力的选择。需要开展涉及更多患者的进一步研究。
