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Article: Preemptive immunosuppressive treatment for asymptomatic serological reactivation may reduce renal flares in patients with lupus nephritis: a cohort study
Title | Preemptive immunosuppressive treatment for asymptomatic serological reactivation may reduce renal flares in patients with lupus nephritis: a cohort study |
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Authors | |
Keywords | Asymptomatic Immunology Lupus nephritis Preemptive treatment Serological reactivation |
Issue Date | 2019 |
Publisher | Oxford 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? |
Abstract | Background:
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 Identifier | http://hdl.handle.net/10722/260521 |
ISSN | 2023 Impact Factor: 4.8 2023 SCImago Journal Rankings: 1.414 |
ISI Accession Number ID |
DC Field | Value | Language |
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dc.contributor.author | Yap, YHD | - |
dc.contributor.author | Kwan, PYL | - |
dc.contributor.author | Ma, KMM | - |
dc.contributor.author | Mok, MYM | - |
dc.contributor.author | Chan, GCW | - |
dc.contributor.author | Chan, DTM | - |
dc.date.accessioned | 2018-09-14T08:43:03Z | - |
dc.date.available | 2018-09-14T08:43:03Z | - |
dc.date.issued | 2019 | - |
dc.identifier.citation | Nephrology Dialysis Transplantation, 2019, v. 34 n. 3, p. 467-473 | - |
dc.identifier.issn | 0931-0509 | - |
dc.identifier.uri | http://hdl.handle.net/10722/260521 | - |
dc.description.abstract | Background: 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.language | eng | - |
dc.publisher | Oxford University Press. The Journal's web site is located at http://ndt.oxfordjournals.org/ | - |
dc.relation.ispartof | Nephrology Dialysis Transplantation | - |
dc.rights | This 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.subject | Asymptomatic | - |
dc.subject | Immunology | - |
dc.subject | Lupus nephritis | - |
dc.subject | Preemptive treatment | - |
dc.subject | Serological reactivation | - |
dc.title | Preemptive immunosuppressive treatment for asymptomatic serological reactivation may reduce renal flares in patients with lupus nephritis: a cohort study | - |
dc.type | Article | - |
dc.identifier.email | Yap, YHD: desmondy@hku.hk | - |
dc.identifier.email | Kwan, PYL: kpy472@hku.hk | - |
dc.identifier.email | Ma, KMM: h9914584@graduate.hku.hk | - |
dc.identifier.email | Chan, GCW: gcwchan1@hku.hk | - |
dc.identifier.email | Chan, DTM: dtmchan@hkucc.hku.hk | - |
dc.identifier.authority | Yap, YHD=rp01607 | - |
dc.identifier.authority | Chan, DTM=rp00394 | - |
dc.description.nature | postprint | - |
dc.identifier.doi | 10.1093/ndt/gfy024 | - |
dc.identifier.pmid | 29509932 | - |
dc.identifier.scopus | eid_2-s2.0-85062408244 | - |
dc.identifier.hkuros | 290756 | - |
dc.identifier.volume | 34 | - |
dc.identifier.issue | 3 | - |
dc.identifier.spage | 467 | - |
dc.identifier.epage | 473 | - |
dc.identifier.isi | WOS:000461162000015 | - |
dc.publisher.place | United Kingdom | - |
dc.identifier.issnl | 0931-0509 | - |