Clinical observation of multi-target therapy in children with lupus nephritis / 中华风湿病学杂志

ABSTRACT

Objective To explore the efficacy of mycophenolate mofetil-based induction or maintenance therapy for children with lupus nephritis combined with Calcineurin inhibitors (cyclosporine A/tacrolimus) for resistant cases.Methods the clinical data were analyzed for 10 patients treated with multi-target therapy (Glucocorticoid + Mycophenolate mofetile+ Cyclosporine A/Tacrolimus) in Department of Nephrology and Rheumatology from January 2005 to December 2011.Calcineurin inhibitor (Cyclosporine A/Tacrolimus) was added when Mycophenolate mofetil-based induction or maintenance protocol was not satisfactory.The data was analyzed by repeated measures data of ANOVA.Results The SLEDAI score (10.9±3.8 vs 7.9±2.6),24 hours urinary protein quantification [(4.0±2.0) vs (2.2±1.8) g] and ESR [(78±10) vs (54±8) mm/l h] were decreased significantly (P＜0.01),while serum albumin [(29±8) vs (34±8) g/L] and complement C3 level [(0.41±0.20) vs (0.70±0.30) g/L] were increased significantly (P＜0.05).The complete remission rate (CR) was 70％ and the response rate was 90％ in the first 6 month,and the CR was 90％ in the last month.Except 1 case withdrawal,the follow-up period for 9 cases was 24 months.Adverse reactions were rare,1 case had lung in-fection,1 case had hyperglycemia and 1 case had transaminase elevation,which disappeared after mana-gement.Conclusion Mycophenolate mofetil combined with Calcineurin inhibitors (cyclosporine A/tacrolimus) is effective for treating lupus nephritis,the dose of induction or maintenance period is low,and adverse reactions are rare.