Τίτλος:
Repeat kidney biopsies fail to detect differences between azathioprine
and mycophenolate mofetil maintenance therapy for lupus nephritis: data
from the MAINTAIN Nephritis Trial
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Background. In the MAINTAIN Nephritis Trial, azathioprine (AZA) and
mycophenolate mofetil (MMF) were compared as maintenance
immunosuppressive treatment of proliferative lupus nephritis (LN) after
a short-course of intravenous cyclophosphamide. Here, we compare the
pathological findings on repeat kidney biopsies between the two groups.
Methods. Per protocol, repeat renal biopsies were obtained in 30
patients (16 AZA and 14 MMF) at 2 years (+/-6 months). Baseline and
follow-up biopsies were graded according to the International Society of
Nephrology/Renal Pathological Society (ISN/RPS) classification. The
activity and chronicity indices (AI, CI) were calculated using two
different semiquantitative scoring systems (Morel-Maroger and National
Institutes of Health). Statistics were performed by non-parametric
tests.
Results. The clinical characteristics of the 30 re-biopsied patients
only marginally differ from the entire MAINTAIN cohort (105 patients).
Clinical baseline and follow-up characteristics of AZA- and MMF-treated
re-biopsied patients did not differ. Time (SD) to repeat renal biopsy
was 25.0 (2.0) and 26.5 (3.3) months in AZA and MMF patients,
respectively. More patients had normal renal biopsies or Classes I/II/V
LN at follow-up compared to baseline and conversely, less patients had
Class IV LN at follow-up. In both groups, the AI statistically decreased
at follow-up compared to baseline, while the CI slightly, but
significantly, increased. No differences could be detected between the
groups.
Conclusion. Centralized pathological analyses, including ISN/RPS
classification and comparisons of AI/CI, failed to find differences
between MMF and AZA at 2 years, a result well in line with the absence
of difference in long-term clinical outcome reported elsewhere.
Συγγραφείς:
Stoenoiu, Maria S.
Aydin, Selda
Tektonidou, Maria and
Ravelingien, Isabelle
le Guern, Veronique
Fiehn, Christoph and
Remy, Philippe
Delahousse, Michel
Petera, Peter
Quemeneur,
Thomas
Vasconcelos, Carlos
D'Cruz, David
Gilboe,
Inge-Magrethe
Jadoul, Michel
Karras, Alexandre
Depresseux,
Genevieve
Guillevin, Loic
Cervera, Ricard
Cosyns,
Jean-Pierre
Houssiau, Frederic A.
MAINTAIN Nephritis Trial Grp
Περιοδικό:
Nephrology Dialysis Transplantation
Εκδότης:
Oxford University Press
Λέξεις-κλειδιά:
azathioprine; lupus nephritis; mycophenolate mofetil; pathology; renal
biopsy
