霉酚酸酯与基于环磷酰胺的诱导方案治疗狼疮性肾炎：巴基斯坦拉合尔一家三级护理中心的结果。

Mycophenolate mofetil vs. cyclophosphamide-based induction regimens for lupus nephritis: Outcomes at a tertiary care centre in Lahore, Pakistan.

机构信息

Department of Rheumatology, Fatima Memorial Hospital, College of Medicine and Dentistry, Lahore, Pakistan.

出版信息

J Pak Med Assoc. 2024 May;74(5):868-873. doi: 10.47391/JPMA.8694.

DOI:10.47391/JPMA.8694

PMID:38783432

Abstract

OBJECTIVES

To compare the efficacy of mycophenolate mofetil with intravenous cyclophosphamideas induction therapy in lupus nephritis.

METHODS

The observational, prospecrive, cohort study was conducted at the Rheumatology Department of Fatima Memorial Hospital, Lahore, Pakistan, from July 2016 to June 2019, and comprised lupus nephritis patients. For induction therapy, the patients were assigned at the discretion of the treating rheumatologist to mycophenolate mofetil group MMF, and intravenous cyclophosphamide group CYC. The latter group was further divided into NIH subgroup that received the therapy as per the protocol of the National Institutes of Health, and ELNT subgroup which recived the therapy as per the Euro Lupus Nephritis Trial protocol. Maintenance therapy in all groups was mycophenolate mofetil. Tacrolimus was added in case of non-response. The outcome was the achievement of complete renal response at 6, 12 and 24 months. Data was analysed using SPSS 26.

RESULTS

Of the 131 patients, 126(96.2%) were females. The overall mean age was 27±7.7 years. There were 58(44.2%) patients in group MMF and 73(55.7%) in group CYC, which had subgroup NIH 46(63%) and subgrpup ELNT 27(37%). The complete renal response rates at 6, 12, and 24 months were 22 (43.1%), 35 (71.4%), and 40(83.3%) for group MMF; 5(12.5%), 9(22%) and 24 (58.5%) for subgroup NIH, and 6(26.1%), 8(36.4%) and 14(63.6%) for subgroup ELNT. Group MMF outcomes were significantly better than the rest (p<0.05).

CONCLUSIONS

Mycophenolate mofetil induction therapy was more effective than intraveenous cyclophosphamide in terms of achieving remission at 6, 12 and 24 months.

摘要

目的

比较吗替麦考酚酯与静脉注射环磷酰胺作为狼疮肾炎诱导治疗的疗效。

方法

这是一项在巴基斯坦拉合尔法蒂玛纪念医院风湿科进行的观察性、前瞻性队列研究，时间为 2016 年 7 月至 2019 年 6 月，纳入狼疮肾炎患者。对于诱导治疗，根据治疗风湿科医生的判断，将患者分配至吗替麦考酚酯组（MMF）和静脉注射环磷酰胺组（CYC）。后者进一步分为 NIH 亚组，按照美国国立卫生研究院的方案进行治疗，ELNT 亚组，按照欧洲狼疮肾炎试验方案进行治疗。所有组别的维持治疗均为吗替麦考酚酯。如果没有反应，则加用他克莫司。主要结局是在 6、12 和 24 个月时达到完全肾脏缓解。使用 SPSS 26 进行数据分析。

结果

131 例患者中，126 例（96.2%）为女性。平均年龄为 27±7.7 岁。MMF 组 58 例（44.2%），CYC 组 73 例（55.7%），其中 NIH 亚组 46 例（63%），ELNT 亚组 27 例（37%）。MMF 组在 6、12 和 24 个月时的完全肾脏缓解率分别为 22（43.1%）、35（71.4%）和 40（83.3%）；NIH 亚组分别为 5（12.5%）、9（22%）和 24（58.5%）；ELNT 亚组分别为 6（26.1%）、8（36.4%）和 14（63.6%）。MMF 组的结局明显优于其他组（p<0.05）。