Comparative efficacy of intravenous cyclophosphamide, mycophenolate mofetil, and tacrolimus as induction therapy for lupus nephritis: A randomized controlled open-label trial.

IF 1.9 4区 医学 Q3 RHEUMATOLOGY
Lupus Pub Date : 2025-10-01 Epub Date: 2025-07-14 DOI:10.1177/09612033251361560
Alekhya Amudalapalli, Rasmi Ranjan Sahoo, Ashlesha Shukla, Abhichandra Maddineni, Sandeep Nagar, Roshani Sridhar, Sudhish Gadde, Harish Buvanahalli Venkatshappa, Sumanth Madan, Gargi Sasmal, Pradeepta Sekhar Patro
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Abstract

ObjectiveTo compare the efficacy of cyclophosphamide (IV CYC), mycophenolate mofetil (MMF), and tacrolimus (TAC), as induction treatment for lupus nephritis (LN).MethodsThis randomized, open-label, non-inferiority, active-controlled three-arm study included children and adult patients aged ≥10 years with clinical or biopsy-proven LN over a period of 1 year. Patients were randomized in a 1:1:1 ratio to receive IV CYC (0.5-0.75 g/m2 monthly for 6 doses), MMF (2-3 g/day), or TAC (0.08-1 mg/kg/day). The primary outcome was the proportion of patients achieving renal response [complete (CR) or partial (PR)] at week 24 and secondary outcomes included the proportion of CR, PR, change in complements, anti-dsDNA antibody, and 24-hour urine protein levels, SLEDAI-2K and renal-SLEDAI scores from baseline to week 24. Serum CXCL10 was assessed at baseline and follow-up. Intention-to-treat analysis was performed.Results82 patients (94% females; median age 27.5 years) were randomized to receive IV CYC (28), MMF (27), and TAC (27). At 24 weeks, the renal response rates were 53.5%, 66.6%, and 62.9% in IV CYC, MMF, and, TAC groups, respectively. The lower limit of the confidence interval for the difference in renal response at 24 weeks between treatment groups was less than 20% (non-inferiority margin) (p = .58). Serum CXCL10 reduced significantly post-treatment in all three groups (p < .001). Three patients in the IV CYC group and one patient in TAC group died due to serious infections.ConclusionTAC was non-inferior compared to IV CYC and MMF for LN as induction therapy, with a comparable safety profile during the study period.

静脉注射环磷酰胺、霉酚酸酯和他克莫司诱导治疗狼疮性肾炎的比较疗效:一项随机对照开放标签试验。
目的比较环磷酰胺(IV CYC)、霉酚酸酯(MMF)和他克莫司(TAC)诱导治疗狼疮性肾炎(LN)的疗效。方法:这项随机、开放标签、非劣效性、主动对照的三组研究纳入了年龄≥10岁、临床或活检证实为LN的儿童和成人患者,研究时间为1年。患者按1:1:1的比例随机接受静脉注射CYC(每月0.5-0.75 g/m2,共6剂)、MMF (2-3 g/天)或TAC (0.08-1 mg/kg/天)。主要结局是在第24周达到肾反应[完全(CR)或部分(PR)]的患者比例,次要结局包括从基线到第24周的CR、PR比例、补体变化、抗dsdna抗体和24小时尿蛋白水平、SLEDAI-2K和肾脏- sledai评分。在基线和随访时评估血清CXCL10。进行意向治疗分析。结果82例患者(94%为女性;中位年龄27.5岁)随机接受IV CYC(28)、MMF(27)和TAC(27)。24周时,IV CYC组、MMF组和TAC组的肾脏反应率分别为53.5%、66.6%和62.9%。治疗组之间24周肾脏反应差异的置信区间下限小于20%(非劣效性边界)(p = 0.58)。治疗后三组血清CXCL10均显著降低(p < 0.001)。IV CYC组3例,TAC组1例因严重感染死亡。结论:与IV CYC和MMF相比,tac作为LN诱导治疗的效果并不差,在研究期间具有相当的安全性。
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
Lupus
Lupus 医学-风湿病学
CiteScore
4.20
自引率
11.50%
发文量
225
审稿时长
1 months
期刊介绍: The only fully peer reviewed international journal devoted exclusively to lupus (and related disease) research. Lupus includes the most promising new clinical and laboratory-based studies from leading specialists in all lupus-related disciplines. Invaluable reading, with extended coverage, lupus-related disciplines include: Rheumatology, Dermatology, Immunology, Obstetrics, Psychiatry and Cardiovascular Research…
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