#rheumatology #lupus #medicaleducation
Walk down the memory lane and get a brief overview of LN tx trials over the last two decades. NOT a complete list but still a helpful educational video for busy rheumatology fellows.
Medical disclaimer:
This channel does not provide medical advice. If you’re a patient, please consult your physician for medical advice as there are many nuances and details in the field of rheumatology and the general information may not apply to you personally.
Educational disclaimer:
The information presented is meant to be an additional supplement to one’s learning.I will not be operating as a clinical preceptor nor will I be able to answer any specific question regarding a clinical case/patient. Always seek the advice of a preceptor(s) at your training program.
References:
Tian M, Song X, Dong L, Xin X, Dong J. Systematic evaluation of different doses of cyclophosphamide induction therapy for lupus nephritis. Medicine (Baltimore). 2017 Dec;96(51):e9408. doi: 10.1097/MD.0000000000009408. PMID: 29390559; PMCID: PMC5758261.
Houssiau FA, Vasconcelos C, D'Cruz D, Sebastiani GD, Garrido Ed Ede R, Danieli MG, Abramovicz D, Blockmans D, Mathieu A, Direskeneli H, Galeazzi M, Gül A, Levy Y, Petera P, Popovic R, Petrovic R, Sinico RA, Cattaneo R, Font J, Depresseux G, Cosyns JP, Cervera R. Immunosuppressive therapy in lupus nephritis: the Euro-Lupus Nephritis Trial, a randomized trial of low-dose versus high-dose intravenous cyclophosphamide. Arthritis Rheum. 2002 Aug;46(8):2121-31. doi: 10.1002/art.10461. PMID: 12209517.
Mycophenolate Mofetil versus Cyclophosphamide for Induction Treatment of Lupus Nephritis
Gerald B. Appel, Gabriel Contreras, Mary Anne Dooley, Ellen M. Ginzler, David Isenberg, David Jayne, Lei-Shi Li, Eduardo Mysler, Jorge Sánchez-Guerrero, Neil Solomons, David Wofsy
JASN May 2009, 20 (5) 1103-1112; DOI: 10.1681/ASN.2008101028
Dooley MA, Jayne D, Ginzler EM, Isenberg D, Olsen NJ, Wofsy D, Eitner F, Appel GB, Contreras G, Lisk L, Solomons N; ALMS Group. Mycophenolate versus azathioprine as maintenance therapy for lupus nephritis. N Engl J Med. 2011 Nov 17;365(20):1886-95. doi: 10.1056/NEJMoa1014460. PMID: 22087680.
Houssiau FA, D'Cruz D, Sangle S, Remy P, Vasconcelos C, Petrovic R, Fiehn C, de Ramon Garrido E, Gilboe IM, Tektonidou M, Blockmans D, Ravelingien I, le Guern V, Depresseux G, Guillevin L, Cervera R; MAINTAIN Nephritis Trial Group. Azathioprine versus mycophenolate mofetil for long-term immunosuppression in lupus nephritis: results from the MAINTAIN Nephritis Trial. Ann Rheum Dis. 2010 Dec;69(12):2083-9. doi: 10.1136/ard.2010.131995. Epub 2010 Sep 10. PMID: 20833738; PMCID: PMC3002764.
Tamirou F, D'Cruz D, Sangle S, Remy P, Vasconcelos C, Fiehn C, Ayala Guttierez Mdel M, Gilboe IM, Tektonidou M, Blockmans D, Ravelingien I, le Guern V, Depresseux G, Guillevin L, Cervera R, Houssiau FA; MAINTAIN Nephritis Trial Group. Long-term follow-up of the MAINTAIN Nephritis Trial, comparing azathioprine and mycophenolate mofetil as maintenance therapy of lupus nephritis. Ann Rheum Dis. 2016 Mar;75(3):526-31. doi: 10.1136/annrheumdis-2014-206897. Epub 2015 Mar 10. PMID: 25757867; PMCID: PMC4789692.
Rovin BH, Furie R, Latinis K, Looney RJ, Fervenza FC, Sanchez-Guerrero J, Maciuca R, Zhang D, Garg JP, Brunetta P, Appel G; LUNAR Investigator Group. Efficacy and safety of rituximab in patients with active proliferative lupus nephritis: the Lupus Nephritis Assessment with Rituximab study. Arthritis Rheum. 2012 Apr;64(4):1215-26. doi: 10.1002/art.34359. Epub 2012 Jan 9. PMID: 22231479.
Liu Z, Zhang H, Liu Z, Xing C, Fu P, Ni Z, Chen J, Lin H, Liu F, He Y, He Y, Miao L, Chen N, Li Y, Gu Y, Shi W, Hu W, Liu Z, Bao H, Zeng C, Zhou M. Multitarget therapy for induction treatment of lupus nephritis: a randomized trial. Ann Intern Med. 2015 Jan 6;162(1):18-26. doi: 10.7326/M14-1030. PMID: 25383558.
Multitarget Therapy for Maintenance Treatment of Lupus Nephritis
Haitao Zhang, Zhengzhao Liu, Minlin Zhou, Zhangsuo Liu, Jianghua Chen, Changying Xing, Hongli Lin, Zhaohui Ni, Ping Fu, Fuyou Liu, Nan Chen, Yongcheng He, Jianshe Liu, Caihong Zeng, Zhihong Liu
JASN Dec 2017, 28 (12) 3671-3678; DOI: 10.1681/ASN.2017030263
Furie et al. Two-Year, Randomized, Controlled Trial of Belimumab in Lupus Nephritis
N Engl J Med 2020; 383:1117-1128
DOI: 10.1056/NEJMoa2001180
Rovin et al.Efficacy and safety of voclosporin versus placebo for lupus nephritis (AURORA 1): a double-blind, randomized, multicenter, placebo-controlled, phase 3 trial. Published May 07, 2021 DOI: doi.org/10.1016/S0140-6736(21...
Timecodes
0:00- Intro/Disclaimer/Objectives
1:15- What is NIH dosing Regimen?
3:00- Euro Lupus Trial 2002
4:00- ALMS Induction 2009
5:40- ALMS Maintenance 2011
7:10- MAINTAIN 2010
9:36- LUNAR 2012
10:45-MT Induction 2015
14:00- MT Maintenance 2017
16:46- BLISS 2020
18:48- AURORA 2021