Long-term follow-up of the MAINTAIN Nephritis Trial, comparing azathioprine and mycophenolate mofetil as maintenance therapy of lupus nephritis

OBJECTIVE: To report the 10-year follow-up of the MAINTAIN Nephritis Trial comparing azathioprine (AZA) and mycophenolate mofetil (MMF) as maintenance therapy of proliferative lupus nephritis, and to test different definitions of early response as predictors of long-term renal outcome. METHODS: In 2014, data on survival, kidney function, 24 h proteinuria, renal flares and other outcomes were collected for the 105 patients randomised between 2002 and 2006, except in 13 lost to follow-up. RESULTS: Death (2 and 3 in the AZA and MMF groups, respectively) and end-stage renal disease (1 and 3, respectively) were rare events. Time to renal flare (22 and 19 flares in AZA and MMF groups, respectively) did not differ between AZA and MMF patients. Patients with good long-term renal outcome had a much more stringent early decrease of 24 h proteinuria compared with patients with poor outcome. The positive predictive value of a 24 h proteinuria <0.5 g/day at 3 months, 6 months and 12 months for a good long-term renal outcome was excellent (between 89% and 92%). Inclusion of renal function and urinalysis in the early response criteria did not impact the value of early proteinuria decrease as long-term prognostic marker. CONCLUSIONS: The long-term follow-up data of the MAINTAIN Nephritis Trial do not indicate that MMF is superior to AZA as maintenance therapy in a Caucasian population suffering from proliferative lupus nephritis. Moreover, we confirm the excellent positive predictive value of an early proteinuria decrease for long-term renal outcome

Azathioprine versus mycophenolate mofetil for long-term immunosuppression in lupus nephritis: results from the MAINTAIN Nephritis Trial

Background: Long-term immunosuppressive treatment does not efficiently prevent relapses of lupus nephritis (LN). This investigator-initiated randomised trial tested whether mycophenolate mofetil (MMF) was superior to azathioprine (AZA) as maintenance treatment. Methods: A total of 105 patients with lupus with proliferative LN were included. All received three daily intravenous pulses of 750 mg methylprednisolone, followed by oral glucocorticoids and six fortnightly cyclophosphamide intravenous pulses of 500 mg. Based on randomisation performed at baseline, AZA (target dose: 2 mg/kg/day) or MMF (target dose: 2 g/day) was given at week 12. Analyses were by intent to treat. Time to renal flare was the primary end point. Mean (SD) follow-up of the intent-to-treat population was 48 (14) months. Results: The baseline clinical, biological and pathological characteristics of patients allocated to AZA or MMF did not differ. Renal flares were observed in 13 (25%) AZA-treated and 10 (19%) MMF-treated patients. Time to renal flare, to severe systemic flare, to benign flare and to renal remission did not statistically differ. Over a 3-year period, 24 h proteinuria, serum creatinine, serum albumin, serum C3, haemoglobin and global disease activity scores improved similarly in both groups. Doubling of serum creatinine occurred in four AZA-treated and three MMF-treated patients. Adverse events did not differ between the groups except for haematological cytopenias, which were statistically more frequent in the AZA group (p=0.03) but led only one patient to drop out. Conclusions: Fewer renal flares were observed in patients receiving MMF but the difference did not reach statistical significance.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

A framework for remission in SLE: consensus findings from a large international task force on definitions of remission in SLE (DORIS)

Objectives Treat-to-target recommendations have identified 'remission' as a target in systemic lupus erythematosus (SLE), but recognise that there is no universally accepted definition for this. Therefore, we initiated a process to achieve consensus on potential definitions for remission in SLE. Methods An international task force of 60 specialists and patient representatives participated in preparatory exercises, a face-to-face meeting and follow-up electronic voting. The level for agreement was set at 90%. Results The task force agreed on eight key statements regarding remission in SLE and three principles to guide the further development of remission definitions: 1. Definitions of remission will be worded as follows: remission in SLE is a durable state characterised by . (reference to symptoms, signs, routine labs). 2. For defining remission, a validated index must be used, for example, clinical systemic lupus erythematosus disease activity index (SLEDAI)=0, British Isles lupus assessment group (BILAG) 2004 D/E only, clinical European consensus lupus outcome measure (ECLAM)=0; with routine laboratory assessments included, and supplemented with physician's global assessment. 3. Distinction is made between remission off and on therapy: remission off therapy requires the patient to be on no other treatment for SLE than maintenance antimalarials; and remission on therapy allows patients to be on stable maintenance antimalarials, low-dose corticosteroids (prednisone ≤5 mg/day), maintenance immunosuppressives and/or maintenance biologics. The task force also agreed that the most appropriate outcomes (dependent variables) for testing the prognostic value (construct validity) of potential remission definitions are: death, damage, flares and measures of health-related quality of life. Conclusions The work of this international task force provides a framework for testing different definitions of remission against long-term outcomes

Détection de Clostridium difficile toxinogène par biologie moléculaire avec le BD Max CDiff RUO

Clostridium difficile est l agent pathogène le plus fréquemment retrouvé en cas de diarrhée nosocomiale. Cette étude a pour but d évaluer le BD Max Cdiff RUO, un nouvel automate en finalisation de marquage CE-IVD recherchant le gène tcdB dans les selles par rapport à la méthode d immunochromatographie actuellement employée par le laboratoire de bactériologie du CHU de Lille. Les échantillons ont également été testés sur le BD GeneOhm, un autre automate détectant la présence du gène tcdB. La méthode de référence choisie est l isolement en culture après choc alcoolique d une souche de C. difficile toxinogène. 360 échantillons de selles diarrhéiques provenant de patients hospitalisés au CHU de Lille ont été inclus de manière prospective de janvier à février 2012. La sensibilité des techniques de biologie moléculaire (97.73% pour le BD Max, 95.45% pour le BD GeneOhm) est supérieure à celle du test immunochromatographique évalué (43.18%). Les valeurs prédictives positive et négative du BD Max sont respectivement de 97.73% et 99.68% contre 95% et 92.65% pour l immunochromatographie. Le faible rapport de vraisemblance négatif de l immunochromatographie (RV - = 0.57) ne permet pas d éliminer une infection à C. difficile en cas de suspicion clinique, contrairement aux techniques de biologie moléculaire (RV- < 0.1). Le BD Max Cdiff RUO a des performances similaires à la culture toxigénique avec des résultats disponibles en seulement 2 heures au lieu de 2 à 3 jours. Un diagnostic rapide et fiable permet de traiter aussi tôt que possible une infection potentiellement létale ainsi que d implémenter des mesures d hygiène nécessaires à la prévention des épidémies hospitalières.LILLE2-BU Santé-Recherche (593502101) / SudocSudocFranceF

Molecular methods in the diagnosis of Clostridium difficile infections: an update

International audienc

Psychrobacter sanguinis: an Unusual Bacterium for Nosocomial Meningitis

International audienc

A new case of Mycoplasma hominis mediastinitis and sternal osteitis after cardiac surgery

We report a case of nosocomial mediastinitis and sternal osteitis due to M. hominis after open-heart surgery in an immuno-competent patient. This infection has been diagnosed by incubating the culture media for an extended period of time, and sequencing 16S rDNA directly from the clinical samples

The Brief Case: Mycoplasma hominis Extragenital Abscess

International audienc

Closing the Brief Case: Mycoplasma hominis Extragenital Abscess

International audienc