強い分子間相互作用をもつ有機ビラジカロイドの電子状態の解明と有機電界効果トランジスタへの応用

東京理科大学201

Comparison of renal response to four different induction therapies in Japanese patients with lupus nephritis class III or IV: A single-centre retrospective study.

The recent recommendations for the management of lupus nephritis suggest that racial background should be considered while choosing induction therapy. However, the responses to different induction regimens have been poorly studied in Japanese population. Here, we assessed the renal response to different induction therapies in Japanese patients with lupus nephritis class III or IV. The records of 64 patients with biopsy-proven lupus nephritis class III or IV were retrospectively evaluated according to therapy received: monthly intravenous cyclophosphamide (IVCY), the Euro-lupus nephritis trial (ELNT) protocol-IVCY, tacrolimus (TAC), or mycophenolate mofetil (MMF). We investigated cumulative complete renal response (CR) rates and relapse rates for each group for 3 years. Organ damage was assessed with the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI). There were 22 patients on monthly IVCY, 18 on ELNT-IVCY, 13 on TAC, and 11 on MMF. Lower systemic lupus erythematosus disease activity index (SLEDAI) and higher CH50 were found in the TAC group at baseline (p<0.01 and p<0.01, respectively). There were no significant differences of cumulative CR rates and relapse free survival for 3 years among the four different therapeutic regimens (p = 0.2 and p = 0.2, respectively). There was a tendency to have early response and early relapse in TAC group and late response in MMF group. The SDI increase over 3 years was found more frequently in the TAC group than in the monthly-IVCY group (p = 0.04). Multivariate analysis indicated that CR at 3 months was independent prognosticator for low damage accrual. Regarding lower damage accrual, early CR achievement might be essential in induction therapy regardless of immunosuppressant choice

Adverse events during 3 years.

<p>Adverse events during 3 years.</p

Relapse free rate for 3 years after CR achievement.

<p>There was no significant difference among the four treatment groups. CR, Complete renal response; IVCY, intravenous cyclophosphamide; ELNT, Euro-Lupus Nephritis Trial; TAC, Tacrolimus; MMF, mycophenolate mofetil.</p

Percentage of patients with increasing damage accrual for 3 years.

<p>A higher percentage of patients on TAC had increasing SDI for 3 years compared to those on monthly IVCY (p = 0.04). Montly-IVCY vs ELNT-IVCY, p = 0.55; ELNT-IVCY vs MMF; p = 0.11; MMF vs TAC, p = 0.63; monthly-IVCY vs MMF, p = 0.10, ELNT-IVCY vs TAC, p = 0.32. SDI, Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index; IVCY, intravenous cyclophosphamide; ELNT, Euro-Lupus Nephritis Trial; TAC, Tacrolimus; MMF, mycophenolate mofetil.</p

% Change of eGFR from baseline.

<p>There was statistically no significant difference among 4 groups (p = 0.3). IVCY, intravenous cyclophosphamide; ELNT, Euro-Lupus Nephritis Trial; TAC, Tacrolimus; MMF, mycophenolate mofetil; eGFR, estimated glomerular filtration rate.</p

Cumulative complete renal response rate for 3 years after induction therapy.

<p>Cumulative complete renal response rate is not significantly different among the four treatment groups (p = 0.2). CR, Complete renal response; IVCY, intravenous cyclophosphamide; ELNT, Euro-Lupus Nephritis Trial; TAC, Tacrolimus; MMF, mycophenolate mofetil.</p

Component of SDI and renal damage at 3 years.

<p>Percentage of corticosteroid-related or not corticosteroid-related damage of SDI in 4 groups was shown (p = 0.05). TAC group has higher corticosteroid-related damage than IVCY groups.</p

Baseline clinical and renal pathological features of lupus nephritis patients with immunosuppressive therapy.

<p>Baseline clinical and renal pathological features of lupus nephritis patients with immunosuppressive therapy.</p

Multivariate analysis for predictors of patients with increasing SDI over 3 years.

<p>Multivariate analysis for predictors of patients with increasing SDI over 3 years.</p