Kagawa Hidetoshi, Yamanaka Ryutaro, Hiromasa Tsutomu
Department of Nephrology and Rheumatology, Japanese Red Cross Society Himeji Hospital.
Acta Med Okayama. 2022 Oct;76(5):547-555. doi: 10.18926/AMO/64036.
This observational study aimed to clarify the long-term results of the combination of mizoribine (MZB), tacrolimus (TAC) and prednisolone as first-line therapy for lupus nephritis (LN). This was our institution's standard therapy between 2009 and 2015, when we saw 36 patients with LN. When a patient thus treated achieved SLEDAI remission (= 0) and/or the prednisolone dose could be tapered to 5 mg/day, either MZB or TAC was stopped, and the other was continued for maintenance therapy. If treatment failure or relapse occurred, second-line therapy was introduced. At years 1 and 5, overall complete renal response and SLEDAI remission were 94% and 88%, and 50% and 62%, respectively. Excluding 2 cases lost to follow-up, medications after 5 years were as follows: 20 (59%) were stable on 1 drug (MZB or TAC), 11 (32%) required continuation of both drugs (MZB + TAC), and 3 (9%) required second-line therapy. The 5-year retention rate was 91% (non-secondline), with 0% of relapse in this group. Our first-line combination strategy showed high remission rates in the induction phase, and subsequent maintenance therapy demonstrated good outcomes for up to 5 years. Research that fine-tunes the order of therapeutic agents and institutes appropriate treatment goals may further improve long-term outcomes for patients with LN.
这项观察性研究旨在阐明咪唑立宾（MZB）、他克莫司（TAC）和泼尼松龙联合作为狼疮性肾炎（LN）一线治疗的长期结果。这是我们机构在2009年至2015年期间的标准治疗方法，在此期间我们诊治了36例LN患者。当接受该治疗的患者实现SLEDAI缓解（=0）和/或泼尼松龙剂量可减至5mg/天时，停用MZB或TAC中的一种，继续使用另一种进行维持治疗。如果发生治疗失败或复发，则引入二线治疗。在第1年和第5年时，总体完全肾脏缓解率和SLEDAI缓解率分别为94%和88%，以及50%和62%。排除2例失访病例后，5年后的用药情况如下：20例（59%）仅使用1种药物（MZB或TAC）病情稳定，11例（32%）需要继续使用两种药物（MZB+TAC），3例（9%）需要二线治疗。5年保留率为91%（非二线治疗组），该组复发率为0%。我们的一线联合治疗策略在诱导期显示出高缓解率，随后的维持治疗在长达5年的时间里都取得了良好的效果。对治疗药物顺序进行微调并制定适当治疗目标的研究可能会进一步改善LN患者的长期治疗效果。
