Renal Response Outcomes of the EuroLupus and National Institutes of Health Cyclophosphamide Dosing Regimens in Childhood‐Onset Proliferative Lupus Nephritis
Objective We compared clinical characteristics and renal response in patients with childhood‐onset proliferative lupus nephritis (LN) treated with the EuroLupus versus National Institutes of Health (NIH) cyclophosphamide (CYC) regimen. Methods A retrospective cohort study was conducted at 11 pediatr...
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Published in | Arthritis & rheumatology (Hoboken, N.J.) Vol. 76; no. 3; pp. 469 - 478 |
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Main Authors | , , , , , , , , , , , , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
Boston, USA
Wiley Periodicals, Inc
01.03.2024
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Subjects | |
Online Access | Get full text |
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Summary: | Objective
We compared clinical characteristics and renal response in patients with childhood‐onset proliferative lupus nephritis (LN) treated with the EuroLupus versus National Institutes of Health (NIH) cyclophosphamide (CYC) regimen.
Methods
A retrospective cohort study was conducted at 11 pediatric centers in North America that reported using both CYC regimens. Data were extracted from the electronic medical record at baseline and 3, 6, and 12 months after treatment initiation with CYC. To evaluate the adjusted association between CYC regimen (EuroLupus vs NIH) and renal response over time, generalized estimating equations with a logit link were used. An interaction between time and CYC regimen was included, and a contrast between CYC regimens at 12 months was used to evaluate the primary outcome.
Results
One hundred forty‐five patients (58 EuroLupus, 87 NIH) were included. EuroLupus patients were on average older at the start of current CYC therapy, had longer disease duration, and more commonly had relapsed or refractory LN compared with the NIH group. After multivariable adjustment, there was no significant association between CYC regimen and achieving complete renal response at 12 months (odds ratio [OR] of response for the EuroLupus regimen, reference NIH regimen: 0.76; 95% confidence interval [CI] 0.29–1.98). There was also no significant association between CYC regimen and achieving at least a partial renal response at 12 months (OR 1.35, 95% CI 0.57–3.19).
Conclusion
Our study failed to demonstrate a benefit of the NIH regimen over the EuroLupus CYC regimen in childhood‐onset proliferative LN. However, future prospective outcome studies are needed. |
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Bibliography: | Author disclosures and graphical abstract are available at Supported by the Childhood Arthritis and Rheumatology Research Alliance (CARRA)–Arthritis Foundation and the Lupus Foundation of America. Dr. Wang's work was supported by the National Center for Advancing Translational Sciences, NIH, Colorado Clinical and Translational Science Institute grant UL1‐TR‐002535. Dr. Lewandowski's work was supported by the Intramural Research Program of the National Arthritis and Musculoskeletal and Skin Diseases, NIH. Additional supplementary information cited in this article can be found online in the Supporting Information section https://onlinelibrary.wiley.com/doi/10.1002/art.42725 The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. . http://onlinelibrary.wiley.com/doi/10.1002/art.42725 |
ISSN: | 2326-5191 2326-5205 |
DOI: | 10.1002/art.42725 |