Document Detail


Withdrawal of therapy in patients with proliferative lupus nephritis: long-term follow-up.
MedLine Citation:
PMID:  16455674     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Whether corticosteroid and immunosuppressive therapy may be safely withdrawn in patients with proliferative lupus nephritis is still unclear. METHODS: In 32 patients with biopsy-proven proliferative lupus nephritis previously put into remission, therapy was gradually tapered off. RESULTS: When immunosuppressive therapy was stopped (median: 38 months; 25th-75th percentile: 24-81 months, after biopsy), 24 patients were in complete remission and eight had a median proteinuria of 1.05 g/24 h (25th-75th percentile: 0.91-1.1 g/24 h) with normal renal function. After stopping therapy, patients were followed for a median of 203 months (25th-75th percentile: 116-230 months). Fifteen patients (Group 1) never developed lupus activity. The other 17 patients (Group 2) developed lupus exacerbations in a median of 34 months (25th-75th percentile: 29-52 months) after stopping therapy and were re-treated. The only significant differences between the two groups were the longer median durations of treatment, 57 months (25th-75th percentile: 41.5-113.5 months) vs 30 months (25th-75th percentile: 18-41 months; P<0.009), and remission, 24 months (25th-75th percentile: 18-41) vs 12 months (25th-75th percentile: 7-20 months; P<0.02), before stopping therapy in Group 1 than in Group 2. At last follow-up, 12 patients of Group 1 were in complete remission, two had mild proteinuria and one had died. In Group 2, one patient died, 14 were in complete remission, one had mild proteinuria and in another patient serum creatinine doubled. CONCLUSIONS: Some patients with severe lupus nephritis who enter stable remission can be maintained without any specific treatment for many years. Those patients who have new flares can again go into remission with an appropriate treatment. The longer the treatment and remission before withdrawal, the lower the risk of relapse.
Authors:
Gabriella Moroni; Beniamina Gallelli; Silvana Quaglini; Giovanni Banfi; Emilio Rivolta; Piergiorgio Messa; Claudio Ponticelli
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2006-02-02
Journal Detail:
Title:  Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association     Volume:  21     ISSN:  0931-0509     ISO Abbreviation:  Nephrol. Dial. Transplant.     Publication Date:  2006 Jun 
Date Detail:
Created Date:  2006-05-22     Completed Date:  2006-11-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8706402     Medline TA:  Nephrol Dial Transplant     Country:  England    
Other Details:
Languages:  eng     Pagination:  1541-8     Citation Subset:  IM    
Affiliation:
Division of Nephrology, Ospedale Maggiore IRCCS, Via Commenda 15, 20122 Milan, Italy. gmoroni@policlinico.mi.it
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MeSH Terms
Descriptor/Qualifier:
Adrenal Cortex Hormones / administration & dosage*
Adult
Female
Follow-Up Studies
Humans
Immunosuppressive Agents / administration & dosage*
Lupus Nephritis / drug therapy*
Male
Recurrence
Remission Induction
Retrospective Studies
Treatment Outcome
Chemical
Reg. No./Substance:
0/Adrenal Cortex Hormones; 0/Immunosuppressive Agents
Comments/Corrections
Comment In:
Nat Clin Pract Nephrol. 2006 Dec;2(12):672-3   [PMID:  17124522 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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