Predictors of response to the high dose intravenous cyclophosphamide in Egyptian lupus nephritis patients: A retrospective cohort study

IF 0.5 Q3 Health Professions

Revista Colombiana de Reumatologia Pub Date : 2026-07-01 Epub Date: 2025-02-27 DOI:10.1016/j.rcreu.2024.12.003

Doaa Attia, Nessma Abdel-Malik, Dina Effat

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引用次数: 0

Abstract

Objectives

To identify the predictors of response to the high dose intravenous cyclophosphamide (IV CYC) in Egyptian patients with lupus nephritis using the commonly used laboratory tests.

Materials and methods

Data were collected retrospectively at baseline (T₀), and after 3 (T₁), and 6 (T₂) cycles of CYC. The percentages of laboratory values at T₁ relative to T₀ [(T₁/T₀) × 100] were calculated to detect the potential predictors of response. ROC curves and Youden index were used to determine the cut-off values that best predict complete, partial, and global responses [CR, PR, GR (CR + PR), respectively].

Results

One hundred eighteen patients were included. At T₂, 40 (33.9%) patients had achieved CR, 28 (23.7%) patients had PR, and 50 (42.4%) patients were resistant to treatment. The percent changes of platelet count, complement 3 (C3) level, and 24-h proteinuria were significantly different between the three groups (p = .042, .029, <.001, respectively). Concerning CR, the AUC for proteinuria was the greatest (AUC = .763, p = <.001). Accordingly, the cut-off value of the percent change of proteinuria for CR prediction was 72.3% with 87.5% sensitivity and 55.1% specificity. Concerning GR, the AUC for C3 (AUC = .788, p = .011) and proteinuria (AUC = .810, p = <.001) were the highest. Accordingly, the cut-off value of the percent change of C3 for GR prediction was 145.11% with 76.9% sensitivity and 85.7% specificity, while that of proteinuria was 78.34% with 86.8% sensitivity and 66% specificity.

Conclusions

The magnitude of change in proteinuria and C3 levels during the early course of IV CYC could predict the final response to the drug.

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埃及狼疮性肾炎患者静脉注射高剂量环磷酰胺反应的预测因素：一项回顾性队列研究

目的探讨埃及狼疮性肾炎患者对高剂量静脉注射环磷酰胺（IV CYC）反应的预测因素。材料和方法回顾性收集基线（T0）、CYC 3 （T1）和6 （T2）周期后的数据。计算T1时实验室值相对于T0的百分比[（T1/T0） × 100]，以检测反应的潜在预测因子。使用ROC曲线和Youden指数来确定最能预测完全、部分和整体反应的临界值[CR， PR, GR （CR + PR）分别]。结果共纳入118例患者。T2时，40例（33.9%）患者达到CR， 28例（23.7%）患者达到PR， 50例（42.4%）患者对治疗产生耐药性。三组患者血小板计数、补体3 （C3）水平、24小时蛋白尿百分比变化差异有统计学意义（p = 0.042, p = 0.042）。029, <.001)。CR中，蛋白尿的AUC最大（AUC = .763, p = <.001）。据此，蛋白尿变化百分比预测CR的临界值为72.3%，敏感性为87.5%，特异性为55.1%。GR方面，C3 （AUC = .788, p = .011）和蛋白尿（AUC = .810, p = <.001）的AUC最高。据此，C3变化百分比预测GR的临界值为145.11%，敏感性为76.9%，特异性为85.7%；而蛋白尿的临界值为78.34%，敏感性为86.8%，特异性为66%。结论静脉注射CYC早期蛋白尿和C3水平的变化幅度可以预测药物的最终疗效。

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

Revista Colombiana de Reumatologia Medicine-Rheumatology

CiteScore

0.80

自引率

0.00%

发文量

期刊介绍： The Colombian Journal of Rheumatology (Revista Colombiana de Reumatología) is the official organ of the Colombian Association of Rheumatology (Asociación Colombiana de Reumatología) and the Central American, Caribbean and Andean Association of Rheumatology (Asociación Centroamericana Caribe Andina de Reumatología) - ACCA. It was created in December 1993 with the purpose of disseminating scientific information derived from primary and secondary research and presenting cases coming from the practice of Rheumatology in Latin America. Since its foundation, the Journal has been characterized by its plurality with subjects of all rheumatic and osteomuscular pathologies, in the form of original articles, historical articles, economic evaluations, and articles of reflection and education in Medicine. It covers an extensive area of topics ranging from the broad spectrum of the clinical aspects of rheumatology and related areas in autoimmunity (both in pediatric and adult pathologies), to aspects of basic sciences. It is an academic tool for the different members of the academic and scientific community at their different levels of training, from undergraduate to post-doctoral degrees, managing to integrate all actors inter and trans disciplinarily. It is intended for rheumatologists, general internists, specialists in related areas, and general practitioners in the country and abroad. It has become an important space in the work of all rheumatologists from Central and South America.