A Randomized Controlled Trial Comparing Remission Induction with Modified Multitarget Therapy with Intravenous...

Area of Science:

• Nephrology
• Immunology
• Rheumatology

Background:

• Standard therapy for proliferative lupus nephritis (PLN) involves intravenous cyclophosphamide (IV CYC) and steroids, but concerns exist regarding end-stage renal disease (ESRD) progression, mortality, and adverse effects.
• Multitarget therapy (MTT) with tacrolimus, mycophenolate, and steroids can induce remission but is associated with high infection rates.

Purpose of the Study:

• To evaluate the efficacy and safety of a modified multitarget therapy (MMTT) replacing mycophenolate with azathioprine for PLN induction.
• To compare MMTT with standard IV CYC therapy in patients with biopsy-proven PLN.

Main Methods:

• A single-center, 24-week, open-label, randomized controlled trial was conducted with adults aged 18-65 years with biopsy-proven PLN.
• Intervention groups included MMTT (tacrolimus and azathioprine) and IV CYC, both combined with methylprednisolone and oral prednisone.

Main Results:

• Overall remission rates were comparable between MMTT (86.36%) and IV CYC (87.75%) at 24 weeks.
• Both groups showed similar improvements in proteinuria, SLEDAI scores, and C3 complement levels.
• Adverse events were numerically higher in the IV CYC group, including one death from pneumonia.

Conclusions:

• Modified multitarget therapy (MMTT) demonstrates comparable efficacy to IV CYC for short-term outcomes in PLN.
• MMTT presents a comparable safety profile to IV CYC, suggesting it as a potentially safer alternative for PLN induction.