Combined immunosuppressive treatment (CIST) in lupus nephritis: a multicenter, randomized controlled study

Area of Science:

• Nephrology
• Rheumatology
• Immunosuppressive Therapy

Background:

• Standard lupus nephritis treatment involves glucocorticoids plus cyclophosphamide or mycophenolate mofetil, but remission rates remain suboptimal.
• Higher remission rates are needed to effectively manage lupus nephritis.

Purpose of the Study:

• To evaluate a combined immunosuppressive treatment strategy for achieving higher remission rates in lupus nephritis patients.
• To compare the efficacy and safety of the combined strategy against standard cyclophosphamide therapy.

Main Methods:

• A 24-week randomized trial involving 191 lupus nephritis patients across 17 centers in China.
• Patients received either a combined immunosuppressive treatment (CIST) including cyclophosphamide, mycophenolate mofetil, azathioprine or leflunomide, and hydroxychloroquine, or cyclophosphamide alone, alongside glucocorticoids.
• Primary endpoint was complete remission defined by stringent criteria; secondary endpoint was treatment failure.

Main Results:

• The combined treatment group showed significantly higher complete remission (39.5% vs. 20.8%) and total response rates (87.2% vs. 68.8%) at 24 weeks.
• The combined strategy also resulted in a lower incidence of treatment failure (12.8% vs. 31.2%) compared to cyclophosphamide alone.
• No significant difference in severe adverse events was observed between the two treatment arms.

Conclusions:

• Combined immunosuppressive therapy is more effective than cyclophosphamide monotherapy for lupus nephritis.
• This enhanced treatment strategy offers a superior option for improving patient outcomes in lupus nephritis.