Lupus nephritis in Mexican patients: Response to intensive therapy

IF 1.2 Q4 RHEUMATOLOGY

Reumatologia Clinica Pub Date : 2025-05-01 DOI:10.1016/j.reuma.2025.501896

Georgina Aguilera Barragán-Pickens , David Herrera van-Oostdam , Fedra Irazoque-Palazuelos , Miguel Saavedra-Salinas , Sergio Cerpa-Cruz , Claudia Mendoza-Pinto , Luis Valdez , Enrique Cuevas Orta , Eva Santillán-Guerrero , Carlos Abud-Mendoza , LUNPOS GROUP

{"title":"Lupus nephritis in Mexican patients: Response to intensive therapy","authors":"Georgina Aguilera Barragán-Pickens , David Herrera van-Oostdam , Fedra Irazoque-Palazuelos , Miguel Saavedra-Salinas , Sergio Cerpa-Cruz , Claudia Mendoza-Pinto , Luis Valdez , Enrique Cuevas Orta , Eva Santillán-Guerrero , Carlos Abud-Mendoza , LUNPOS GROUP","doi":"10.1016/j.reuma.2025.501896","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><div>lupus nephritis represents a challenge in treatment. In spite of intensive therapy, is common a sustained renal incomplete response.</div></div><div><h3>Objective</h3><div>To describe different responses to adequate/intensive treatment to lupus nephritis.</div></div><div><h3>Methods</h3><div>Observational retrospective study, including Mexican>18 years old patients with lupus nephritis who visited tertiary rheumatology centers in several urban cities in Mexico. SLE was diagnosed according to 1997 ACR. The exclusion criteria were follow-up<6 months and reduced GFR due to other comorbidities such as diabetes or other primary renal disease.</div></div><div><h3>Results</h3><div>We included 193 patients with a mean age of 34 years, 80% were women. Biopsy was available in 166 patients (86%): class IV in 42%, class III in 23%, the mean of activity and chronicity index were 6.4 and 2.6 respectively; class V represented 10.2%. The least frequent class was Class II (9%), and mixed classes (III or IV+V) accounted for 11%.</div><div>Cyclophosphamide (CYC) was used in 146 patients (76.6%), mycophenolate (MMF) in 144 and tacrolimus (TCR) in 28. In most cases, were used combination therapy.</div><div>Only 38 patients had a follow-up of less than 1 year; 16 (42%) had CR, 13 (34%) had NR, and 9 (23%) PR. 55% of patients with PR received a multitarget protocol, 75% of CR received the NIH protocol, and 61.5% of NR the NIH protocol.</div><div>Of patients followed up for more than a year (155), 35% had persistently inactive response, 24.5% were relapsing–remitting, 20% were chronically active, and 20% showed a mixed pattern.</div></div><div><h3>Conclusions</h3><div>Prevalence of persistent or intermittent activity patterns was high (64.5%). Most Mexican rheumatologists switched to more intensive treatment, adding a second or third drug.</div></div>","PeriodicalId":47115,"journal":{"name":"Reumatologia Clinica","volume":"21 5","pages":"Article 501896"},"PeriodicalIF":1.2000,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Reumatologia Clinica","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1699258X25000907","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"RHEUMATOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Introduction

lupus nephritis represents a challenge in treatment. In spite of intensive therapy, is common a sustained renal incomplete response.

Objective

To describe different responses to adequate/intensive treatment to lupus nephritis.

Methods

Observational retrospective study, including Mexican > 18 years old patients with lupus nephritis who visited tertiary rheumatology centers in several urban cities in Mexico. SLE was diagnosed according to 1997 ACR. The exclusion criteria were follow-up < 6 months and reduced GFR due to other comorbidities such as diabetes or other primary renal disease.

Results

We included 193 patients with a mean age of 34 years, 80% were women. Biopsy was available in 166 patients (86%): class IV in 42%, class III in 23%, the mean of activity and chronicity index were 6.4 and 2.6 respectively; class V represented 10.2%. The least frequent class was Class II (9%), and mixed classes (III or IV + V) accounted for 11%.

Cyclophosphamide (CYC) was used in 146 patients (76.6%), mycophenolate (MMF) in 144 and tacrolimus (TCR) in 28. In most cases, were used combination therapy.

Only 38 patients had a follow-up of less than 1 year; 16 (42%) had CR, 13 (34%) had NR, and 9 (23%) PR. 55% of patients with PR received a multitarget protocol, 75% of CR received the NIH protocol, and 61.5% of NR the NIH protocol.

Of patients followed up for more than a year (155), 35% had persistently inactive response, 24.5% were relapsing–remitting, 20% were chronically active, and 20% showed a mixed pattern.

Conclusions

Prevalence of persistent or intermittent activity patterns was high (64.5%). Most Mexican rheumatologists switched to more intensive treatment, adding a second or third drug.

查看原文本刊更多论文

墨西哥狼疮性肾炎患者：对强化治疗的反应

狼疮性肾炎是治疗中的一个挑战。尽管强化治疗，常见的是持续的肾不完全反应。目的探讨充分/强化治疗对狼疮性肾炎的不同疗效。方法采用观察性回顾性研究，包括墨西哥>；18岁狼疮肾炎患者访问三级风湿病中心在几个城市在墨西哥。根据1997年ACR诊断SLE。排除标准为随访；由于其他合并症，如糖尿病或其他原发性肾脏疾病，GFR降低。结果纳入193例患者，平均年龄34岁，80%为女性。166例（86%）患者进行了活检：IV级占42%，III级占23%，平均活动性和慢性指数分别为6.4和2.6；V类占10.2%。最不常见的是II类（9%），混合类（III或IV + V）占11%。环磷酰胺（CYC） 146例（76.6%），霉酚酸酯（MMF） 144例，他克莫司（TCR） 28例。在大多数情况下，我们使用联合治疗。只有38例患者随访时间少于1年；16例（42%）有CR， 13例（34%）有NR， 9例（23%）有PR。55%的PR患者接受了多靶点方案，75%的CR患者接受了NIH方案，61.5%的NR患者接受了NIH方案。在随访超过一年的患者中（155例），35%的患者持续无反应，24.5%的患者复发缓解，20%的患者长期活跃，20%的患者表现为混合模式。结论持续性或间歇性活动模式的患病率较高（64.5%）。大多数墨西哥风湿病学家转而采用更强化的治疗方法，增加了第二种或第三种药物。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Reumatologia Clinica RHEUMATOLOGY-

CiteScore

2.40

自引率

6.70%

发文量

105

审稿时长

54 days

期刊介绍： Una gran revista para cubrir eficazmente las necesidades de conocimientos en una patología de etiología, expresividad clínica y tratamiento tan amplios. Además es La Publicación Oficial de la Sociedad Española de Reumatología y del Colegio Mexicano de Reumatología y está incluida en los más prestigiosos índices de referencia en medicina.