Therapy of lupus nephritis: controlled trial of prednisone and cytotoxic drugs
We evaluated renal function in 107 patients with active lupus nephritis who participated in long-term randomized therapeutic trials (median follow-up, seven years). For patients taking oral prednisone alone, the probability of renal failure began to increase substantially after five years of observa...
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| Veröffentlicht in: | The New England journal of medicine 1986-03, Vol.314 (10), p.614-619 |
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| container_title | The New England journal of medicine |
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| creator | AUSTIN, H. A. III KLIPPEL, J. H BALOW, J. E LE RICHE, N. G.H STEINBERG, A. D PLOTZ, P. H DECKER, J. L |
| description | We evaluated renal function in 107 patients with active lupus nephritis who participated in long-term randomized therapeutic trials (median follow-up, seven years). For patients taking oral prednisone alone, the probability of renal failure began to increase substantially after five years of observation. Renal function was better preserved in patients who received various cytotoxic-drug therapies, but the difference was statistically significant only for intravenous cyclophosphamide plus low-dose prednisone as compared with high-dose prednisone alone (P = 0.027). The advantage of treatment with intravenous cyclophosphamide over oral prednisone alone was particularly apparent in the high-risk subgroup of patients who had chronic histologic changes on renal biopsy at study entry. Patients treated with intravenous cyclophosphamide have not experienced hemorrhagic cystitis, cancer, or a disproportionate number of major infections. We conclude that, as compared with high-dose oral prednisone alone, treatment of lupus glomerulonephritis with intravenous cyclophosphamide reduces the risk of end-stage renal failure with few serious complications. |
| doi_str_mv | 10.1056/NEJM198603063141004 |
| format | Article |
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A. III ; KLIPPEL, J. H ; BALOW, J. E ; LE RICHE, N. G.H ; STEINBERG, A. D ; PLOTZ, P. H ; DECKER, J. L</creator><creatorcontrib>AUSTIN, H. A. III ; KLIPPEL, J. H ; BALOW, J. E ; LE RICHE, N. G.H ; STEINBERG, A. D ; PLOTZ, P. H ; DECKER, J. L</creatorcontrib><description>We evaluated renal function in 107 patients with active lupus nephritis who participated in long-term randomized therapeutic trials (median follow-up, seven years). For patients taking oral prednisone alone, the probability of renal failure began to increase substantially after five years of observation. Renal function was better preserved in patients who received various cytotoxic-drug therapies, but the difference was statistically significant only for intravenous cyclophosphamide plus low-dose prednisone as compared with high-dose prednisone alone (P = 0.027). The advantage of treatment with intravenous cyclophosphamide over oral prednisone alone was particularly apparent in the high-risk subgroup of patients who had chronic histologic changes on renal biopsy at study entry. Patients treated with intravenous cyclophosphamide have not experienced hemorrhagic cystitis, cancer, or a disproportionate number of major infections. We conclude that, as compared with high-dose oral prednisone alone, treatment of lupus glomerulonephritis with intravenous cyclophosphamide reduces the risk of end-stage renal failure with few serious complications.</description><identifier>ISSN: 0028-4793</identifier><identifier>EISSN: 1533-4406</identifier><identifier>DOI: 10.1056/NEJM198603063141004</identifier><identifier>PMID: 3511372</identifier><identifier>CODEN: NEJMAG</identifier><language>eng</language><publisher>Boston, MA: Massachusetts Medical Society</publisher><subject>Administration, Oral ; Adult ; Azathioprine - administration & dosage ; Azathioprine - adverse effects ; Azathioprine - therapeutic use ; Biological and medical sciences ; Biopsy ; Clinical Trials as Topic ; Creatinine - blood ; Cyclophosphamide - administration & dosage ; Cyclophosphamide - adverse effects ; Cyclophosphamide - therapeutic use ; Drug Therapy, Combination ; Female ; Glomerulonephritis - drug therapy ; Glomerulonephritis - etiology ; Glomerulonephritis - physiopathology ; Humans ; Injections, Intravenous ; Kidney - pathology ; Kidney Failure, Chronic - etiology ; Lupus Erythematosus, Systemic - complications ; Male ; Medical sciences ; Pharmacology. Drug treatments ; Prednisone - administration & dosage ; Prednisone - adverse effects ; Prednisone - therapeutic use ; Random Allocation ; Urinary system</subject><ispartof>The New England journal of medicine, 1986-03, Vol.314 (10), p.614-619</ispartof><rights>1987 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>776</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=7957722$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/3511372$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>AUSTIN, H. A. III</creatorcontrib><creatorcontrib>KLIPPEL, J. H</creatorcontrib><creatorcontrib>BALOW, J. E</creatorcontrib><creatorcontrib>LE RICHE, N. G.H</creatorcontrib><creatorcontrib>STEINBERG, A. D</creatorcontrib><creatorcontrib>PLOTZ, P. H</creatorcontrib><creatorcontrib>DECKER, J. L</creatorcontrib><title>Therapy of lupus nephritis: controlled trial of prednisone and cytotoxic drugs</title><title>The New England journal of medicine</title><addtitle>N Engl J Med</addtitle><description>We evaluated renal function in 107 patients with active lupus nephritis who participated in long-term randomized therapeutic trials (median follow-up, seven years). For patients taking oral prednisone alone, the probability of renal failure began to increase substantially after five years of observation. Renal function was better preserved in patients who received various cytotoxic-drug therapies, but the difference was statistically significant only for intravenous cyclophosphamide plus low-dose prednisone as compared with high-dose prednisone alone (P = 0.027). The advantage of treatment with intravenous cyclophosphamide over oral prednisone alone was particularly apparent in the high-risk subgroup of patients who had chronic histologic changes on renal biopsy at study entry. Patients treated with intravenous cyclophosphamide have not experienced hemorrhagic cystitis, cancer, or a disproportionate number of major infections. We conclude that, as compared with high-dose oral prednisone alone, treatment of lupus glomerulonephritis with intravenous cyclophosphamide reduces the risk of end-stage renal failure with few serious complications.</description><subject>Administration, Oral</subject><subject>Adult</subject><subject>Azathioprine - administration & dosage</subject><subject>Azathioprine - adverse effects</subject><subject>Azathioprine - therapeutic use</subject><subject>Biological and medical sciences</subject><subject>Biopsy</subject><subject>Clinical Trials as Topic</subject><subject>Creatinine - blood</subject><subject>Cyclophosphamide - administration & dosage</subject><subject>Cyclophosphamide - adverse effects</subject><subject>Cyclophosphamide - therapeutic use</subject><subject>Drug Therapy, Combination</subject><subject>Female</subject><subject>Glomerulonephritis - drug therapy</subject><subject>Glomerulonephritis - etiology</subject><subject>Glomerulonephritis - physiopathology</subject><subject>Humans</subject><subject>Injections, Intravenous</subject><subject>Kidney - pathology</subject><subject>Kidney Failure, Chronic - etiology</subject><subject>Lupus Erythematosus, Systemic - complications</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Pharmacology. Drug treatments</subject><subject>Prednisone - administration & dosage</subject><subject>Prednisone - adverse effects</subject><subject>Prednisone - therapeutic use</subject><subject>Random Allocation</subject><subject>Urinary system</subject><issn>0028-4793</issn><issn>1533-4406</issn><fulltext>false</fulltext><rsrctype>article</rsrctype><creationdate>1986</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNo9j0tLAzEYRYMotVZ_gQhZuB1N8uUxcSelvqh1U9clr2kj05khmQHn31uxeDd3cQ4XLkLXlNxRIuT9avH2TnUpCRAJlFNC-AmaUgFQcE7kKZoSwsqCKw3n6CLnL3II5XqCJiAoBcWmaLXehWS6EbcVroduyLgJ3S7FPuYH7NqmT21dB4_7FE39K3Up-CbmtgnYNB67sW_79js67NOwzZforDJ1DlfHnqHPp8V6_lIsP55f54_LYsuA9IWHAEx6YYM1RgktHQPnnNK21Kp0ljAjLLOgQVY8KKKBmSBVJZ2EwHnJZujmb7cb7D74TZfi3qRxc_x14LdHbrIzdZVM42L-15QW6mCxH4a6Xeo</recordid><startdate>19860306</startdate><enddate>19860306</enddate><creator>AUSTIN, H. A. III</creator><creator>KLIPPEL, J. H</creator><creator>BALOW, J. E</creator><creator>LE RICHE, N. G.H</creator><creator>STEINBERG, A. D</creator><creator>PLOTZ, P. H</creator><creator>DECKER, J. L</creator><general>Massachusetts Medical Society</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope></search><sort><creationdate>19860306</creationdate><title>Therapy of lupus nephritis: controlled trial of prednisone and cytotoxic drugs</title><author>AUSTIN, H. A. III ; KLIPPEL, J. H ; BALOW, J. E ; LE RICHE, N. G.H ; STEINBERG, A. D ; PLOTZ, P. H ; DECKER, J. L</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-g230t-d3e326d5bebaa7596c23ccc79b8978cb02a5b2b3936f4e70932ae67f6c63e4482</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1986</creationdate><topic>Administration, Oral</topic><topic>Adult</topic><topic>Azathioprine - administration & dosage</topic><topic>Azathioprine - adverse effects</topic><topic>Azathioprine - therapeutic use</topic><topic>Biological and medical sciences</topic><topic>Biopsy</topic><topic>Clinical Trials as Topic</topic><topic>Creatinine - blood</topic><topic>Cyclophosphamide - administration & dosage</topic><topic>Cyclophosphamide - adverse effects</topic><topic>Cyclophosphamide - therapeutic use</topic><topic>Drug Therapy, Combination</topic><topic>Female</topic><topic>Glomerulonephritis - drug therapy</topic><topic>Glomerulonephritis - etiology</topic><topic>Glomerulonephritis - physiopathology</topic><topic>Humans</topic><topic>Injections, Intravenous</topic><topic>Kidney - pathology</topic><topic>Kidney Failure, Chronic - etiology</topic><topic>Lupus Erythematosus, Systemic - complications</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Pharmacology. Drug treatments</topic><topic>Prednisone - administration & dosage</topic><topic>Prednisone - adverse effects</topic><topic>Prednisone - therapeutic use</topic><topic>Random Allocation</topic><topic>Urinary system</topic><toplevel>peer_reviewed</toplevel><creatorcontrib>AUSTIN, H. A. III</creatorcontrib><creatorcontrib>KLIPPEL, J. H</creatorcontrib><creatorcontrib>BALOW, J. E</creatorcontrib><creatorcontrib>LE RICHE, N. G.H</creatorcontrib><creatorcontrib>STEINBERG, A. D</creatorcontrib><creatorcontrib>PLOTZ, P. H</creatorcontrib><creatorcontrib>DECKER, J. L</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><jtitle>The New England journal of medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>no_fulltext</fulltext></delivery><addata><au>AUSTIN, H. A. III</au><au>KLIPPEL, J. H</au><au>BALOW, J. E</au><au>LE RICHE, N. G.H</au><au>STEINBERG, A. D</au><au>PLOTZ, P. H</au><au>DECKER, J. L</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Therapy of lupus nephritis: controlled trial of prednisone and cytotoxic drugs</atitle><jtitle>The New England journal of medicine</jtitle><addtitle>N Engl J Med</addtitle><date>1986-03-06</date><risdate>1986</risdate><volume>314</volume><issue>10</issue><spage>614</spage><epage>619</epage><pages>614-619</pages><issn>0028-4793</issn><eissn>1533-4406</eissn><coden>NEJMAG</coden><abstract>We evaluated renal function in 107 patients with active lupus nephritis who participated in long-term randomized therapeutic trials (median follow-up, seven years). For patients taking oral prednisone alone, the probability of renal failure began to increase substantially after five years of observation. Renal function was better preserved in patients who received various cytotoxic-drug therapies, but the difference was statistically significant only for intravenous cyclophosphamide plus low-dose prednisone as compared with high-dose prednisone alone (P = 0.027). The advantage of treatment with intravenous cyclophosphamide over oral prednisone alone was particularly apparent in the high-risk subgroup of patients who had chronic histologic changes on renal biopsy at study entry. Patients treated with intravenous cyclophosphamide have not experienced hemorrhagic cystitis, cancer, or a disproportionate number of major infections. We conclude that, as compared with high-dose oral prednisone alone, treatment of lupus glomerulonephritis with intravenous cyclophosphamide reduces the risk of end-stage renal failure with few serious complications.</abstract><cop>Boston, MA</cop><pub>Massachusetts Medical Society</pub><pmid>3511372</pmid><doi>10.1056/NEJM198603063141004</doi><tpages>6</tpages></addata></record> |
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| subjects | Administration, Oral Adult Azathioprine - administration & dosage Azathioprine - adverse effects Azathioprine - therapeutic use Biological and medical sciences Biopsy Clinical Trials as Topic Creatinine - blood Cyclophosphamide - administration & dosage Cyclophosphamide - adverse effects Cyclophosphamide - therapeutic use Drug Therapy, Combination Female Glomerulonephritis - drug therapy Glomerulonephritis - etiology Glomerulonephritis - physiopathology Humans Injections, Intravenous Kidney - pathology Kidney Failure, Chronic - etiology Lupus Erythematosus, Systemic - complications Male Medical sciences Pharmacology. Drug treatments Prednisone - administration & dosage Prednisone - adverse effects Prednisone - therapeutic use Random Allocation Urinary system |
| title | Therapy of lupus nephritis: controlled trial of prednisone and cytotoxic drugs |
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