单位：[1]Department of Rheumatology and Immunology, Peking University People’s Hospital, 11 Xizhimen South Street, Xicheng District, Beijing 100044, China[2]Department of Rheumatology, China Japan Union Hospital, Jilin University, Changchun, China吉林大学中日联谊医院[3]Department of Rheumatology and Immunology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China[4]Department of Rheumatology and Immunology, First Affiliated Hospital, Zhejing University, Hangzhou, China浙江大学医学院附属第一医院[5]Department of Nephrology, Peking University People’s Hospital, Beijing, China[6]Department of Rheumatology, First Affiliated Hospital of Baotou Medical College, Baotou, China内蒙古科技大学包头医学院[7]Department of Clinical Immunology, Fourth Military Medical University Xijing Hospital, Xi’an, China[8]Department of Rheumatology and Immunology, The First Affiliated Hospital of Harbin Medical University, Harbin, China[9]Department of Rheumatology and Immunology, Peking University Third Hospital, Beijing, China[10]Department of Rheumatology and Immunology, Peking University First Hospital, Beijing, China[11]Department of Rheumatology and Immunology, First Affiliated Hospital of China Medical University, Shenyang, China[12]Department of Rheumatology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China院本部南沙医院内科风湿免疫科内科风湿免疫科中山大学附属第一医院[13]Department of Nephrology, Peking University First Hospital, Beijing, China[14]Department of Rheumatology and Immunology, China-Japan Friendship Hospital, Beijing, China[15]Department of Rheumatology and Immunology, Second Clinical Hospital, Harbin Medical University, Harbin, China[16]Department of Rheumatology and Immunology, Xiangya Hospital Central South University, Changsha, China[17]Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China四川大学华西医院
ObjectivesThe standard strategy for treating lupus nephritis comprises glucocorticoids together with either intravenous cyclophosphamide or oral mycophenolate mofetil, but the low remission rate is still a challenge in practice. This study was aimed to seek higher remission rate of lupus nephritis using a combined strategy.MethodA 24-week trial was conducted in 17 rheumatology or nephrology centers in China. A total of 191 lupus nephritis patients were randomized to follow a combined immunosuppressive treatment (CIST) with intravenous cyclophosphamide, an oral immunosuppressive agent, namely mycophenolate mofetil, azathioprine or leflunomide, and hydroxychloroquine (n=95), or receive intravenous cyclophosphamide alone (n=96) for 24weeks. Glucocorticoid was given to both groups. The primary end point was a complete remission with a most stringent standard as proteinuria <150mg per 24h, normal urinary sediment, serum albumin, and renal function at 24weeks. The secondary end point was treatment failure at 24weeks.ResultsAt week 24, both the rate of complete remission (39.5%) and total response (87.2%) was higher in the combined group, compared with CYC group (20.8% and 68.8%, p<0.05). The cumulative probability of complete remission was also higher in the combined group (p=0.013). In addition, the combined treatment was superior to routine CYC with less treatment failure (12.8% vs.31.2%, p<0.001). No difference was found between the incidences of severe adverse events in the two arms: 3.2% (3/95 combined group) vs.4.2% (4/96 CYC group).ConclusionTreatment with a combined immunosuppressive agent is superior to routine CYC only therapy in lupus nephritis.
基金：
National Basic Research Program of China (973 program)National Basic Research Program of China [2014CB541901]
第一作者单位：[1]Department of Rheumatology and Immunology, Peking University People’s Hospital, 11 Xizhimen South Street, Xicheng District, Beijing 100044, China
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通讯作者：
推荐引用方式(GB/T 7714)：
An Yuan,Zhou Yunshan,Bi Liqi,et al.Combined immunosuppressive treatment (CIST) in lupus nephritis: a multicenter, randomized controlled study[J].CLINICAL RHEUMATOLOGY.2019,38(4):1047-1054.doi:10.1007/s10067-018-4368-8.
APA：
An, Yuan,Zhou, Yunshan,Bi, Liqi,Liu, Bo,Wang, Hong...&Li, Zhanguo.(2019).Combined immunosuppressive treatment (CIST) in lupus nephritis: a multicenter, randomized controlled study.CLINICAL RHEUMATOLOGY,38,(4)
MLA：
An, Yuan,et al."Combined immunosuppressive treatment (CIST) in lupus nephritis: a multicenter, randomized controlled study".CLINICAL RHEUMATOLOGY 38..4(2019):1047-1054
