Minfang Zhang1, Chaojun Qi1, Yan Zha2, Jian Chen3, Ping Luo4, Li Wang5, Zhuxing Sun6, Jianxin Wan7, Changying Xing8, Song Wang9, Gengru Jiang10, Mindan Sun11, Qinkai Chen12, Jianghua Chen13, Detian Li14, Tianjun Guan15, Zhaohui Ni16. 1. Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China. 2. Department of Nephrology, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China. 3. Department of Nephrology, Fuzhou General Hospital of Nanjing Military Command Area, Fuzhou, China. 4. Department of Nephrology, The Second Hospital of Jilin University, Jilin, China. 5. Department of Nephrology, Sichuan Provincial People's Hospital, Chengdu, Sichuan, China. 6. Department of Nephrology, Wuxi People's Hospital, Wuxi, China. 7. Department of Nephrology, First Affiliated Hospital of Fujian Medical University, Fuzhou, China. 8. Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China. 9. Department of Nephrology, Peking University Third Hospital, Peking, China. 10. Department of Nephrology, Xin Hua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China. 11. Department of Nephrology, First Hospital of Jilin University, Jilin, China. 12. Department of Nephrology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China. 13. Department of The Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China. 14. Department of Nephrology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China. 15. Department of Nephrology, Zhongshan Hospital, Xiamen University, Xiamen, Fujian, China. 16. Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China. profnizh@126.com.
Abstract
OBJECTIVES: A prospective, multi-center, randomized controlled study was conducted to evaluate the efficacy and safety of a 24-week course low-dose leflunomide combined with prednisone in the induction treatment of proliferative lupus nephritis in Chinese patients. METHOD: Patients (n = 100) with biopsy-proved proliferative lupus nephritis were enrolled in this study. They were randomized into two groups and received either leflunomide or cyclophosphamide in conjunction with prednisone for 24 weeks. Leflunomide was given orally with a loading dose of 40 mg/day for 3 days followed by 20 mg/day. Intravenous cyclophosphamide was administered monthly at a dosage of 0.8-1.0 g. The primary efficacy outcome was the frequency of complete remission and partial remission at week 24. The secondary outcomes included changes of urinary protein excretion, serum albumin, complement 3, anti-dsDNA antibody level, and systemic lupus erythematosus disease activity index (SLEDAI) after 24-week therapy. RESULTS:Of 100 patients, 48 receivedleflunomide combined with prednisone and other 52 received cyclophosphamide with concomitant prednisone. There were no statistically significant differences between groups in complete remission rate and partial remission rate. At week 24, 23% of patients in the leflunomide group and 27% of patients in the cyclophosphamide group achieved complete remission (P = 0.64), while 56% of patients in the leflunomide group and 42% of patients in the cyclophosphamide group achieved partial remission at week 24 (P = 0.16). SLEDAI, serum albumin, complement 3, anti-dsDNA antibody level, and urinary protein excretion improved significantly in both groups. No significant difference was seen in the changes of clinical parameters after therapy between the two groups. There was no significant difference in side effects in both groups. CONCLUSIONS: Compared with cyclophosphamide, low-dose leflunomide in combination with prednisone showed both effectiveness and safety in the induction therapy of proliferative lupus nephritis in Chinese patients.
RCT Entities:
OBJECTIVES: A prospective, multi-center, randomized controlled study was conducted to evaluate the efficacy and safety of a 24-week course low-dose leflunomide combined with prednisone in the induction treatment of proliferative lupus nephritis in Chinese patients. METHOD:Patients (n = 100) with biopsy-proved proliferative lupus nephritis were enrolled in this study. They were randomized into two groups and received either leflunomide or cyclophosphamide in conjunction with prednisone for 24 weeks. Leflunomide was given orally with a loading dose of 40 mg/day for 3 days followed by 20 mg/day. Intravenous cyclophosphamide was administered monthly at a dosage of 0.8-1.0 g. The primary efficacy outcome was the frequency of complete remission and partial remission at week 24. The secondary outcomes included changes of urinary protein excretion, serum albumin, complement 3, anti-dsDNA antibody level, and systemic lupus erythematosus disease activity index (SLEDAI) after 24-week therapy. RESULTS: Of 100 patients, 48 received leflunomide combined with prednisone and other 52 received cyclophosphamide with concomitant prednisone. There were no statistically significant differences between groups in complete remission rate and partial remission rate. At week 24, 23% of patients in the leflunomide group and 27% of patients in the cyclophosphamide group achieved complete remission (P = 0.64), while 56% of patients in the leflunomide group and 42% of patients in the cyclophosphamide group achieved partial remission at week 24 (P = 0.16). SLEDAI, serum albumin, complement 3, anti-dsDNA antibody level, and urinary protein excretion improved significantly in both groups. No significant difference was seen in the changes of clinical parameters after therapy between the two groups. There was no significant difference in side effects in both groups. CONCLUSIONS: Compared with cyclophosphamide, low-dose leflunomide in combination with prednisone showed both effectiveness and safety in the induction therapy of proliferative lupus nephritis in Chinese patients.
Entities:
Keywords:
Efficacy; Leflunomide; Lupus nephritis; Prospective study