File Download
  Links for fulltext
     (May Require Subscription)
Supplementary

Article: Preemptive immunosuppressive treatment for asymptomatic serological reactivation may reduce renal flares in patients with lupus nephritis: a cohort study

TitlePreemptive immunosuppressive treatment for asymptomatic serological reactivation may reduce renal flares in patients with lupus nephritis: a cohort study
Authors
KeywordsAsymptomatic
Immunology
Lupus nephritis
Preemptive treatment
Serological reactivation
Issue Date2019
PublisherOxford University Press. The Journal's web site is located at http://ndt.oxfordjournals.org/
Citation
Nephrology Dialysis Transplantation, 2019, v. 34 n. 3, p. 467-473 How to Cite?
AbstractBackground: Serological activity may precede clinical flares of lupus nephritis (LN) but the management of asymptomatic serological reactivation (ASR) remains undefined. Methods: We conducted a retrospective analysis of 138 episodes of ASR, which included 53 episodes in which immunosuppression was increased preemptively and 85 episodes in which treatment was unaltered. Preemptive immunosuppressive treatment comprised increasing the dose of prednisolone to ∼0.5 mg/kg/day, and in patients already on mycophenolate mofetil (MMF) or azathioprine (AZA), increasing the dose to 1.5 g/day and 100 mg/day, respectively. Results: Thirty-four episodes of renal flare occurred during follow-up (88.8 ± 77.3 and 82.8 ± 89.7 months in the preemptive group and controls, respectively), following 5 (9.4%) of preemptively treated ASR and 27 (31.8%) of untreated ASR [hazard ratio 0.3 (confidence interval 0.1–0.7), P = 0.012]. Preemptive treatment was associated with superior survival free of renal relapse (99, 92 and 90% at 6, 12 and 24 month, respectively, compared with 94, 69 and 64% in controls; P = 0.011), whereas survival rate free of extrarenal relapse was similar in the two groups. Preemptively treated patients who did not develop renal flares showed better renal function preservation (estimated glomerular filtration rate slope +0.54 ± 0.43 mL/min/1.73 m2/year, compared with −2.11 ± 0.50 and −1.00 ± 0.33 mL/min/1.73 m2/year, respectively, in controls who did and did not develop subsequent renal flares; P = 0.001 and 0.012, respectively). Preemptive treatment was associated with an increased incidence of gastrointestinal side effects attributed to MMF (P = 0.031), whereas infection rate did not differ between the two groups. Conclusion: A preemptive moderate increase of immunosuppression for ASR in LN patients may reduce renal flares and confer benefit to long-term renal function.
Persistent Identifierhttp://hdl.handle.net/10722/260521
ISSN
2019 Impact Factor: 4.531
2015 SCImago Journal Rankings: 1.780
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorYap, YHD-
dc.contributor.authorKwan, PYL-
dc.contributor.authorMa, KMM-
dc.contributor.authorMok, MYM-
dc.contributor.authorChan, GCW-
dc.contributor.authorChan, DTM-
dc.date.accessioned2018-09-14T08:43:03Z-
dc.date.available2018-09-14T08:43:03Z-
dc.date.issued2019-
dc.identifier.citationNephrology Dialysis Transplantation, 2019, v. 34 n. 3, p. 467-473-
dc.identifier.issn0931-0509-
dc.identifier.urihttp://hdl.handle.net/10722/260521-
dc.description.abstractBackground: Serological activity may precede clinical flares of lupus nephritis (LN) but the management of asymptomatic serological reactivation (ASR) remains undefined. Methods: We conducted a retrospective analysis of 138 episodes of ASR, which included 53 episodes in which immunosuppression was increased preemptively and 85 episodes in which treatment was unaltered. Preemptive immunosuppressive treatment comprised increasing the dose of prednisolone to ∼0.5 mg/kg/day, and in patients already on mycophenolate mofetil (MMF) or azathioprine (AZA), increasing the dose to 1.5 g/day and 100 mg/day, respectively. Results: Thirty-four episodes of renal flare occurred during follow-up (88.8 ± 77.3 and 82.8 ± 89.7 months in the preemptive group and controls, respectively), following 5 (9.4%) of preemptively treated ASR and 27 (31.8%) of untreated ASR [hazard ratio 0.3 (confidence interval 0.1–0.7), P = 0.012]. Preemptive treatment was associated with superior survival free of renal relapse (99, 92 and 90% at 6, 12 and 24 month, respectively, compared with 94, 69 and 64% in controls; P = 0.011), whereas survival rate free of extrarenal relapse was similar in the two groups. Preemptively treated patients who did not develop renal flares showed better renal function preservation (estimated glomerular filtration rate slope +0.54 ± 0.43 mL/min/1.73 m2/year, compared with −2.11 ± 0.50 and −1.00 ± 0.33 mL/min/1.73 m2/year, respectively, in controls who did and did not develop subsequent renal flares; P = 0.001 and 0.012, respectively). Preemptive treatment was associated with an increased incidence of gastrointestinal side effects attributed to MMF (P = 0.031), whereas infection rate did not differ between the two groups. Conclusion: A preemptive moderate increase of immunosuppression for ASR in LN patients may reduce renal flares and confer benefit to long-term renal function.-
dc.languageeng-
dc.publisherOxford University Press. The Journal's web site is located at http://ndt.oxfordjournals.org/-
dc.relation.ispartofNephrology Dialysis Transplantation-
dc.rightsThis is a pre-copy-editing, author-produced PDF of an article accepted for publication in Nephrology Dialysis Transplantation following peer review. The definitive publisher-authenticated version Nephrology Dialysis Transplantation, 2019, v. 34 n. 3, p. 467-473 is available online at: https://doi.org/10.1093/ndt/gfy024-
dc.subjectAsymptomatic-
dc.subjectImmunology-
dc.subjectLupus nephritis-
dc.subjectPreemptive treatment-
dc.subjectSerological reactivation-
dc.titlePreemptive immunosuppressive treatment for asymptomatic serological reactivation may reduce renal flares in patients with lupus nephritis: a cohort study-
dc.typeArticle-
dc.identifier.emailYap, YHD: desmondy@hku.hk-
dc.identifier.emailKwan, PYL: kpy472@hku.hk-
dc.identifier.emailMa, KMM: h9914584@graduate.hku.hk-
dc.identifier.emailChan, GCW: gcwchan1@hku.hk-
dc.identifier.emailChan, DTM: dtmchan@hkucc.hku.hk-
dc.identifier.authorityYap, YHD=rp01607-
dc.identifier.authorityChan, DTM=rp00394-
dc.description.naturepostprint-
dc.identifier.doi10.1093/ndt/gfy024-
dc.identifier.pmid29509932-
dc.identifier.scopuseid_2-s2.0-85062408244-
dc.identifier.hkuros290756-
dc.identifier.volume34-
dc.identifier.issue3-
dc.identifier.spage467-
dc.identifier.epage473-
dc.identifier.isiWOS:000461162000015-
dc.publisher.placeUnited Kingdom-

Export via OAI-PMH Interface in XML Formats


OR


Export to Other Non-XML Formats