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Intravenous cyclophosphamide for lupus nephritis in Thai children
P Vachvanichsanong1, P Dissaneewate, T Winn
1Department of Pediatrics, Prince of Songkla University, Hat Yai, Thailand. vprayong@ratree.psu.ac.th
Insights
This study found that 36-month intravenous cyclophosphamide therapy is effective for severe lupus nephritis in Thai children, showing satisfactory outcomes with minimal complications. Long-term follow-up is recommended to confirm sustained efficacy and safety in pediatric lupus nephritis patients.
Area of Science:
- Pediatric Nephrology
- Rheumatology
- Immunosuppressive Therapy
Background:
- Severe lupus nephritis poses a significant risk to kidney function in children.
- Long-term treatment strategies for pediatric lupus nephritis are crucial for improving patient outcomes.
- Understanding the efficacy of intravenous cyclophosphamide in this population is essential for clinical practice.
Purpose of the Study:
- To evaluate the long-term efficacy and safety of a 36-month course of intravenous cyclophosphamide therapy.
- To assess the impact of this treatment on renal function and immunological markers in Thai children with severe lupus nephritis.
- To determine survival and renal survival rates in this cohort.
Main Methods:
- A prospective study involving Thai children with severe lupus nephritis receiving 36 months of intravenous cyclophosphamide and oral prednisolone.
- Regular monitoring of serum creatinine, creatinine clearance, urinary protein, C3 levels, and complete blood count.
- Statistical analysis included repeated measures ANOVA and Kaplan-Meier survival analysis.
Main Results:
- Sixteen patients completed the 36-month therapy, with a mean age at diagnosis of 12.1 years.
- No significant changes in serum creatinine or creatinine clearance were observed (p > 0.05).
- Significant improvements were noted in C3 levels, hemoglobin, and a decrease in urinary protein and white blood cell count (p < 0.001). The 5-year survival and renal survival rates were 86.5% and 87.5%, respectively.
Conclusions:
- Intravenous cyclophosphamide therapy over 36 months demonstrated satisfactory outcomes with minimal complications in Thai children with severe lupus nephritis.
- The treatment effectively improved immunological markers and maintained renal function in the majority of patients.
- Further long-term follow-up is warranted to fully assess the sustained benefits and potential late complications of this immunosuppressive regimen.
Objective:
To evaluate the efficacy of a 36-month course of intravenous cyclophosphamide therapy for severe lupus nephritis in Thai children between October 1993 and December 2000.
Methods:
Intravenous cyclophosphamide combined with oral prednisolone was given for 36 months to patients with systemic lupus erythematosus (SLE) who had severe renal involvement. Serum creatinine (Cr), creatinine clearance (CCr), urinary protein, C3, and complete blood count (CBC) were measured each visit for intravenous cyclophosphamide. Repeated measures ANOVA and Kaplan-Meier survival analysis were used.
Results:
Of 21 patients enrolled in the study, three died and two were lost to follow-up, leaving 16 patients who completed therapy (13 females and three males) with age at diagnosis 12.1+/-2.3 years (range 7.2-20.6 years). The follow-up period was 6.3+/-2.3 years (range 3.3-13.8 years). Fourteen patients had lupus nephritis WHO classification class IV and two had lupus nephritis WHO classification class II. Hypertension was detected in ten patients. Lowess smoothing curves and repeated measures ANOVA indicated no significant change in Cr and CCr [probability (p) > 0.05)], but significantly increased C3 and haemoglobin and significantly decreased urinary protein and white blood cell count (p < 0.001). Five patients had six episodes of acute renal failure; one died, renal function returned to normal in two patients, two continued to chronic renal failure, and one died of chronic renal failure. The 5-year survival and renal survival were 86.5% and 87.5% (95% CI 55.8-96.5% and 58.6-96.7%), respectively.
Conclusion:
Intravenous cyclophosphamide in severe lupus nephritis in Thai children showed a satisfactory outcome with minimal complications. Further follow-up is needed.
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