Good outcomes with mycophenolate-cyclosporine-based induction protocol in children with severe proliferative lupus nephritis

Abstract

The outcomes of children with severe proliferative lupus nephritis (LN) were examined using a new mycophenolate and cyclosporine-based (MMF—CSA) induction protocol. Sixteen children with LN (WHO class III and IV), 31.3% of whom required dialysis at induction, were retrospectively studied. Median MMF dose was 942 mg/m²/day. Thirteen patients (81%) with persistent proteinuria received CSA. Clinical and laboratory parameters were compared at pre-induction, 6 and 12 months. Treatment outcome was defined by Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), renal function, haematuria, proteinuria and serological markers (complements C3, C4 and anti-dsDNA). Comparing these parameters at induction, 6 months and 12 months, respectively, SLEDAI (25.4 ± 8.7 versus 3.2 ± 2.9 versus 2.9 ± 2.8), serum C3 (47 ± 21 versus 107 ± 27 versus 111 ± 38 mg/dl), C4 (12 ± 14 versus 23 ± 14 versus 22 ± 11 mg/dl) and urine protein (6.97 ± 7.09 versus 0.98 ± 1.56 versus 0.21 ± 0.13 g/ day/1. 73 m²) improved significantly (p < 0.05). Anti-dsDNA titres decreased in 73% by 6 and 12 months (p < 0.05). Complete renal remission was achieved in 7/16 (43.8%) at 6 months and 12/16 (75%) at 12 months, the rest achieving partial remission with no treatment failures. In conclusion, a combination MMF—CSA protocol is an effective therapeutic alternative for induction of children with severe proliferative LN, resulting in significant clinical and serological improvement with minimal adverse effects.

Keywords

cyclosporine mycophenolate mofetil systemic lupus erythematosus

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