Attainment of EULAR/ERA-EDTA targets of therapy with current immunosuppressive regimens and adjustments in treatment: a multicentre, real-life observational study

IF 5.1 2区医学 Q1 RHEUMATOLOGY

RMD Open Pub Date : 2024-09-01 DOI:10.1136/rmdopen-2024-004437

Maria Pappa, Maria Kosmetatou, Antigone Pieta, Myrto Nikoloudaki, Nektarios Marios Liapis, Christina Tsalapaki, Aglaia Chalkia, Evangelia Argyriou, Theodoros Dimitroulas, Myrto Cheila, Georgios Demirtzoglou, Charalampos Papagoras, Andreas Goules, Christina Katsiari, Dimitrios Vassilopoulos, Prodromos Sidiropoulos, Kyriaki A Boki, Petros P Sfikakis, George Liapis, Harikleia Gakiopoulou, Paraskevi V Voulgari, Dimitrios T Boumpas, George Bertsias, Maria G Tektonidou, Antonis Fanouriakis

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引用次数: 0

Abstract

Objective To estimate real-life European Alliance of Associations for Rheumatology (EULAR)/European Renal Association (ERA)-European Dialysis and Transplantation Association (EDTA) response rates and predictors for no response in patients with lupus nephritis (LN) managed with conventional immunosuppressive therapies. Methods Ambidirectional cohort study of patients with new-onset LN (period 2014–to date). Response rates in the first year were calculated, and all treatment modifications were recorded. Univariate and multivariate regression analyses were performed to assess determinants of failure to respond at 12 months. Results 140 patients were included (81.4% women, median (IQR) age at LN diagnosis 38 (22) years). Among them, 32.1% presented with nephrotic range proteinuria, 28.6% with glomerular filtration rate <60 mL/min, 76.6% had proliferative and 19.7% class V LN. Initial treatment consisted of cyclophosphamide in 51.4% of patients (84.7% high-dose, 15.3% low-dose) and mycophenolate in 32.1%. 120 patients had available data at 12 months. EULAR/ERA-EDTA renal response rates at 3, 6 and 12 months were achieved by 72.6%, 78.5% % and 69.2% of patients, respectively. In multivariate analysis, increased Chronicity Index at baseline was associated with failure to achieve either complete or partial response at 12 months (OR 2.26, 95% CI 1.35 to 3.77). Notably, 20% of patients required treatment modifications due to suboptimal response during the first 12 months, with the addition of or switch to a different immunosuppressive drug in seven and nine patients, respectively. Conclusions More than two-thirds of patients with LN attain EULAR/ERA-EDTA response rates by 12 months, but 20% require therapy modifications within this time period. Patients with increased chronicity in baseline biopsy, when combined with histological activity, are at higher risk for a lack of clinical response. Data are available upon reasonable request.

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使用当前免疫抑制方案达到 EULAR/ERA-EDTA 治疗目标以及调整治疗方案：一项多中心真实观察研究

目的估计欧洲风湿病学协会联盟（EULAR）/欧洲肾脏协会（ERA）-欧洲透析与移植协会（EDTA）对接受常规免疫抑制疗法治疗的狼疮性肾炎（LN）患者的真实反应率和无反应的预测因素。方法对新发狼疮性肾炎患者进行双向队列研究（2014 年至今）。计算第一年的应答率，并记录所有治疗调整。进行单变量和多变量回归分析，以评估 12 个月时未能应答的决定因素。结果共纳入 140 名患者（81.4% 为女性，确诊 LN 时的中位（IQR）年龄为 38（22）岁）。其中，32.1%出现肾病范围蛋白尿，28.6%肾小球滤过率<60 mL/min，76.6%为增殖性LN，19.7%为V级LN。51.4%的患者接受了环磷酰胺初始治疗（84.7%为大剂量，15.3%为小剂量），32.1%的患者接受了霉酚酸盐初始治疗。120名患者在12个月时有可用数据。72.6%、78.5%和69.2%的患者在3、6和12个月时达到了EULAR/ERA-EDTA肾脏反应率。在多变量分析中，基线慢性化指数的增加与12个月时未能获得完全或部分应答有关（OR 2.26，95% CI 1.35 至 3.77）。值得注意的是，20%的患者在最初的12个月中因疗效不佳而需要调整治疗方案，分别有7名和9名患者需要添加或更换不同的免疫抑制剂。结论超过三分之二的LN患者在12个月内达到EULAR/ERA-EDTA反应率，但20%的患者在此期间需要调整治疗方案。基线活检中慢性化程度增加的患者，如果合并组织学活动，则缺乏临床反应的风险更高。如有合理要求，可提供相关数据。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

RMD Open RHEUMATOLOGY-

CiteScore

7.30

自引率

6.50%

发文量

205

审稿时长

14 weeks

期刊介绍： RMD Open publishes high quality peer-reviewed original research covering the full spectrum of musculoskeletal disorders, rheumatism and connective tissue diseases, including osteoporosis, spine and rehabilitation. Clinical and epidemiological research, basic and translational medicine, interesting clinical cases, and smaller studies that add to the literature are all considered.