Induction therapy for pediatric onset class IV lupus nephritis: Mycophenolate Mofetil versus Cyclophosphamide.

Adult Humans Child Lupus Nephritis / diagnosis Mycophenolic Acid / therapeutic use Immunosuppressive Agents / therapeutic use Retrospective Studies Induction Chemotherapy Cyclophosphamide / therapeutic use
Cyclophosphamide Lupus erythematosus Mycophenolate Mofetil Nephritis Pediatric Systemic Treatment outcome

Journal

Journal of nephrology
ISSN: 1724-6059
Titre abrégé: J Nephrol
Pays: Italy
ID NLM: 9012268

Informations de publication

Date de publication:
04 2023
Historique:
received: 04 05 2022
accepted: 08 08 2022
medline: 13 4 2023
pubmed: 9 10 2022
entrez: 8 10 2022
Statut: ppublish

Résumé

Class IV lupus nephritis (LN) is one of the most frequent and severe types of involvement in pediatric systemic lupus erythematosus. Gold standard treatment consists of intravenous (i.v.) Cyclophosphamide (CYC) associated with corticosteroids. Recent studies in adults have shown similar efficacy of oral Mycophenolate Mofetil (MMF) with fewer adverse events. Our aim was to compare the efficacy and tolerance of CYC and MMF as induction therapy in children with class IV LN. We conducted a retrospective study of children diagnosed with class IV LN who started oral MMF or i.v. CYC treatment at Necker Enfants Malades Hospital (Paris, France). The study included 33 patients, 17 treated with oral MMF (51%) and 16 with i.v. CYC (48%). The characteristics at treatment induction did not significantly differ between the two groups except for the neurological involvement, that was only present in the CYC group. Complete remission was obtained in 9/17 (53%) children treated with MMF versus 10/16 (71%) treated with CYC (p = 0.46). Relapse was observed in 59% of patients receiving MMF versus 50% receiving CYC (p = 0.87), after a median of 3.4 years and 4.7 years after the beginning of treatment, respectively (p = 0.41). During the 6.5 years of follow-up, we observed no significant difference regarding the number of treatment-related adverse events between the two groups (p = 0.48). We report similar efficacy and tolerance of MMF or CYC as induction therapy of class IV LN in children. However, the long-term adverse events such as infertility could not be systematically evaluated in this retrospective pediatric study. Overall, however, considering the long-term safety profile reported in the literature, we suggest that MMF may be used as first-line induction therapy in LN.

Identifiants

DOI: 10.1007/s40620-022-01438-2 PMID: 36208405
pubmed: 36208405
doi: 10.1007/s40620-022-01438-2
pii: 10.1007/s40620-022-01438-2
doi:

Substances chimiques

Mycophenolic Acid HU9DX48N0T
Immunosuppressive Agents 0
Cyclophosphamide 8N3DW7272P

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

829-839

Informations de copyright

© 2022. The Author(s) under exclusive licence to Italian Society of Nephrology.

Références

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Auteurs

Marwa Chbihi (M)

Pediatric Immunology-Hematology and Rheumatology Unit, Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, Inserm U1163, Necker-Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Imagine Institute, Paris, France. marwa.chbihi2@aphp.fr.
ORCID: 0000-0002-2771-851X

Laurye-Anne Eveillard (LA)

Pediatric Nephrology, Inserm U1163, MARHEA Reference Center, Imagine Institute, Paris Cité University, Necker-Enfants Malades Hospital, APHP, Paris, France.

Quentin Riller (Q)

Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, Inserm U1163, Paris Cité University, Imagine Institute, Paris, France.

Romain Brousse (R)

Department of Pathology, Necker-Enfants Malades Hospital, APHP, Paris Cité University, Paris, France.

Romain Berthaud (R)

Pediatric Nephrology, MARHEA Reference Center, Paris Cité University, Necker-Enfants Malades Hospital, AP-HP, Paris, France.

Pierre Quartier (P)

Pediatric Immunology-Hematology and Rheumatology Unit, Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, Inserm U1163, Necker-Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Imagine Institute, Paris, France.

Rémi Salomon (R)

Pediatric Nephrology, Inserm U1163, MARHEA Reference Center, Imagine Institute, Paris Cité University, Necker-Enfants Malades Hospital, APHP, Paris, France.

Marina Charbit (M)

Pediatric Nephrology, Inserm U1163, MARHEA Reference Center, Imagine Institute, Paris Cité University, Necker-Enfants Malades Hospital, APHP, Paris, France.

Marina Avramescu (M)

Pediatric Nephrology, Inserm U1163, MARHEA Reference Center, Imagine Institute, Paris Cité University, Necker-Enfants Malades Hospital, APHP, Paris, France.

Nathalie Biebuyck (N)

Pediatric Nephrology, Inserm U1163, MARHEA Reference Center, Imagine Institute, Paris Cité University, Necker-Enfants Malades Hospital, APHP, Paris, France.

Laurène Dehoux (L)

Pediatric Nephrology, Inserm U1163, MARHEA Reference Center, Imagine Institute, Paris Cité University, Necker-Enfants Malades Hospital, APHP, Paris, France.

Nicolas Garcelon (N)

Inserm U1163, Imagine Institute, Paris Center University, Paris, France.
Inserm, Cordeliers Research Center, U1138, team 22, Paris Cité University, Paris, France.

Jean-Paul Duong-Van-Huyen (JP)

Department of Pathology, Necker-Enfants Malades Hospital, APHP, Paris Cité University, Paris, France.

Brigitte Bader-Meunier (B)

Pediatric Immunology-Hematology and Rheumatology Unit, Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, Inserm U1163, Necker-Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Imagine Institute, Paris, France.

Olivia Boyer (O)

Pediatric Nephrology, Inserm U1163, MARHEA Reference Center, Imagine Institute, Paris Cité University, Necker-Enfants Malades Hospital, APHP, Paris, France.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Induction therapy for pediatric onset class IV...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Induction therapy for pediatric onset class IV...
questionsmedicales.fr › Personnes › Tranches d'âge › Enfant › Induction therapy for pediatric onset class IV...
questionsmedicales.fr › Maladies du système immunitaire › Maladies auto-immunes › Lupus érythémateux disséminé › Glomérulonéphrite lupique › Induction therapy for pediatric onset class IV...
questionsmedicales.fr › Lipides › Acides gras › Acide mycophénolique › Induction therapy for pediatric onset class IV...
questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Effets physiologiques des médicaments › Facteurs immunologiques › Immunosuppresseurs › Induction therapy for pediatric onset class IV...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Induction therapy for pediatric onset class IV...
questionsmedicales.fr › Thérapeutique › Induction de rémission › Chimiothérapie d'induction › Induction therapy for pediatric onset class IV...
questionsmedicales.fr › Composés chimiques organiques › Composés organiques du phosphore › Phosphoramides › Moutardes phosphoramide › Cyclophosphamide › Induction therapy for pediatric onset class IV...