Ann Rheum Dis:比较他克莫司与霉酚酸酯诱导治疗狼疮性肾炎随机对照试验的长期结局

2020-05-29 xiangting MedSci原创

长期数据证实,TAC作为LN的诱导治疗并不亚于MMF。

这项研究旨在报告一项随机对照试验中使用霉酚酸酯(MMF)或他克莫司(TAC)诱导治疗狼疮性肾炎(LN)的10年结局。

活动性LN患者使用MMF或TAC联合大剂量泼尼松龙治疗。第6个月时,应答者换为硫唑嘌呤(AZA)治疗。评估10年时的临床结局(肾脏急性发作、肾功能下降和死亡)。通过Cox回归分析影响预后的因素。通过受试者工作特征曲线(ROC)分析评估不同时间点的尿蛋白/肌酐比值(uPCr)和估算肾小球滤过率(eGFR)对不良预后的预测价值。

共研究了150名患者(年龄35.5±12.8岁)。MMF(59%)和TAC(62%; p=0.71)治疗患者的完全肾脏应答率相似。79%的患者使用AZA维持治疗。118.2±42个月后,MMF患者中分别有34%和37%的患者出现了蛋白尿和肾炎发作,而TAC组患者分别为53%和30%(p=0.49)。两组10年时eGFR下降≥30%、慢性肾脏病分期4/5级或死亡复合结局的累积发生率均为33%(p=0.90)。与肾脏预后不良独立相关的因素是初次LN(HR 0.12(0.031-0.39);p=0.01)、eGFR(HR 0.98(0.96-0.99);p=0.008)和6个月无应答(HR 5.18(1.40-19.1);p=0.01)。ROC分析显示,第18个月时uPCr>0.75、eGFR<80mL/min预测肾脏预后不良的价值最高。

长期数据证实,TAC作为LN的诱导治疗并不亚于MMF。18个月时uPCr≤0.75和eGFR≥80mL/min能够最好地预测10年的良好结局,并且是诱导/巩固治疗的适当目标。

原始出处:

Chi Chiu Mok. Long-term outcome of a randomised controlled trial comparing tacrolimus with mycophenolate mofetil as induction therapy for active lupus nephritis. Ann Rheum Dis. 25 May 2020

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    2020-10-29 amyloid
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time=2020-05-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=600853, encodeId=5522600853a3, content=TAC作为LN的诱导治疗并不亚于MMF, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Fri May 29 23:44:32 CST 2020, time=2020-05-29, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=1775502, encodeId=431c1e755021a, content=<a href='/topic/show?id=937d46650bf' target=_blank style='color:#2F92EE;'>#对照#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46650, encryptionId=937d46650bf, topicName=对照)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8ae138776909, createdName=amyloid, createdTime=Thu Oct 29 19:21:51 CST 2020, time=2020-10-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1987266, encodeId=6bc8198e26686, content=<a href='/topic/show?id=bac5466546c' target=_blank style='color:#2F92EE;'>#对照试验#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46654, encryptionId=bac5466546c, topicName=对照试验)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ad9f79, 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time=2020-05-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=600853, encodeId=5522600853a3, content=TAC作为LN的诱导治疗并不亚于MMF, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Fri May 29 23:44:32 CST 2020, time=2020-05-29, status=1, ipAttribution=)]
  6. [GetPortalCommentsPageByObjectIdResponse(id=1775502, encodeId=431c1e755021a, content=<a href='/topic/show?id=937d46650bf' target=_blank style='color:#2F92EE;'>#对照#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46650, encryptionId=937d46650bf, topicName=对照)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8ae138776909, createdName=amyloid, createdTime=Thu Oct 29 19:21:51 CST 2020, time=2020-10-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1987266, encodeId=6bc8198e26686, content=<a href='/topic/show?id=bac5466546c' target=_blank style='color:#2F92EE;'>#对照试验#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46654, encryptionId=bac5466546c, topicName=对照试验)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ad9f79, 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  7. 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time=2020-05-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=600853, encodeId=5522600853a3, content=TAC作为LN的诱导治疗并不亚于MMF, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Fri May 29 23:44:32 CST 2020, time=2020-05-29, status=1, ipAttribution=)]
  8. [GetPortalCommentsPageByObjectIdResponse(id=1775502, encodeId=431c1e755021a, content=<a href='/topic/show?id=937d46650bf' target=_blank style='color:#2F92EE;'>#对照#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46650, encryptionId=937d46650bf, topicName=对照)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8ae138776909, createdName=amyloid, createdTime=Thu Oct 29 19:21:51 CST 2020, time=2020-10-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1987266, encodeId=6bc8198e26686, content=<a href='/topic/show?id=bac5466546c' target=_blank style='color:#2F92EE;'>#对照试验#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46654, encryptionId=bac5466546c, topicName=对照试验)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ad9f79, 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  9. [GetPortalCommentsPageByObjectIdResponse(id=1775502, encodeId=431c1e755021a, content=<a href='/topic/show?id=937d46650bf' target=_blank style='color:#2F92EE;'>#对照#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46650, encryptionId=937d46650bf, topicName=对照)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8ae138776909, createdName=amyloid, createdTime=Thu Oct 29 19:21:51 CST 2020, time=2020-10-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1987266, encodeId=6bc8198e26686, content=<a href='/topic/show?id=bac5466546c' target=_blank style='color:#2F92EE;'>#对照试验#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46654, encryptionId=bac5466546c, topicName=对照试验)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ad9f79, 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time=2020-05-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=600853, encodeId=5522600853a3, content=TAC作为LN的诱导治疗并不亚于MMF, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Fri May 29 23:44:32 CST 2020, time=2020-05-29, status=1, ipAttribution=)]
    2020-05-31 villahu
  10. 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time=2020-05-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=600853, encodeId=5522600853a3, content=TAC作为LN的诱导治疗并不亚于MMF, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Fri May 29 23:44:32 CST 2020, time=2020-05-29, status=1, ipAttribution=)]
    2020-05-29 lovetcm

    TAC作为LN的诱导治疗并不亚于MMF

    0

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