Abstract
ObjectivesA prospective, multi-center, randomized controlled study was conducted to evaluate the efficacy and safety of a 24-week course low-dose leflunomide combined with prednisone in the induction treatment of proliferative lupus nephritis in Chinese patients.MethodPatients (n = 100) with biopsy–proved proliferative lupus nephritis were enrolled in this study. They were randomized into two groups and received either leflunomide or cyclophosphamide in conjunction with prednisone for 24 weeks. Leflunomide was given orally with a loading dose of 40 mg/day for 3 days followed by 20 mg/day. Intravenous cyclophosphamide was administered monthly at a dosage of 0.8–1.0 g. The primary efficacy outcome was the frequency of complete remission and partial remission at week 24. The secondary outcomes included changes of urinary protein excretion, serum albumin, complement 3, anti-dsDNA antibody level, and systemic lupus erythematosus disease activity index (SLEDAI) after 24-week therapy.ResultsOf 100 patients, 48 received leflunomide combined with prednisone and other 52 received cyclophosphamide with concomitant prednisone. There were no statistically significant differences between groups in complete remission rate and partial remission rate. At week 24, 23% of patients in the leflunomide group and 27% of patients in the cyclophosphamide group achieved complete remission (P = 0.64), while 56% of patients in the leflunomide group and 42% of patients in the cyclophosphamide group achieved partial remission at week 24 (P = 0.16). SLEDAI, serum albumin, complement 3, anti-dsDNA antibody level, and urinary protein excretion improved significantly in both groups. No significant difference was seen in the changes of clinical parameters after therapy between the two groups. There was no significant difference in side effects in both groups.ConclusionsCompared with cyclophosphamide, low-dose leflunomide in combination with prednisone showed both effectiveness and safety in the induction therapy of proliferative lupus nephritis in Chinese patients.
Highlights
Systemic lupus erythematosus (SLE) is an autoimmune disorder often involving multiple systems [1]
There were no significant differences in age, gender, serum creatinine, estimated glomerular filtration rate, urinary protein excretion, serum albumin, complement 3 level, and systemic lupus erythematosus disease activity index (SLEDAI) between the leflunomide group and cyclophosphamide group (Table 1)
The main immunosuppressive regimens recommended for therapy of lupus nephritis include mycophenolate mofetil, cyclophosphamide, and azathioprine [10, 11], but adverse drug reactions such as infection, leucopenia, and liver damage occur in many patients leading to increased morbidity and mortality
Summary
Systemic lupus erythematosus (SLE) is an autoimmune disorder often involving multiple systems [1]. Lupus nephritis (LN), one of the most common complications of SLE, accounts for the most morbidity and mortality [2, 3]. Cyclophosphamide combined with glucocorticoids had been chosen as standard therapy in the induction treatment of lupus. Recent randomized clinical trials showed that mycophenolate mofetil was as effective as cyclophosphamide in inducing remission of LN during the initial phase of therapy [7, 8]. Mycophenolate mofetil is commonly recommended as first-line therapy in LN [9,10,11]. There is a need to find an alternative approach to LN treatment that is as effective as mycophenolate mofetil and with fewer severe adverse effects than mycophenolate mofetil
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