Scholarlink

Background <p>There are few prospective studies of mycophenolate mofetil (MMF) versus cyclophosphamide (CYC) for pediatric lupus nephritis (pLN) and none evaluating rituximab (RTX).</p> Methods <p>The Prospective Pediatric Lupus Nephritis Registry (ProPeL-R) enrolled patients &lt; 21&#xa0;years within 4&#xa0;weeks of an initial kidney biopsy diagnostic of pLN. Demographic, clinical, and laboratory data were collected prospectively at enrollment, 3&#xa0;months, 6&#xa0;months, and then every 6&#xa0;months thereafter for up to 5&#xa0;years of follow-up. For this study, we compared patients receiving initial therapy with corticosteroids (CS) and either MMF (<i>n</i> = 33) vs. CYC (<i>n</i> = 18), and those treated with CS, either MMF or CYC, with RTX (<i>n</i> = 20) vs. without RTX (<i>n</i> = 51).</p> Results <p>Histology consisted of 18% class III; 35% class IV; 25% mixed class; and 22% pure class V. Eighty-two percent were female. No significant differences in response or infection rates were identified between those receiving MMF or CYC. There was a significant increase in combined complete (CR) and partial response (PR) at 24&#xa0;months with RTX use. Overall CR rates at 6 and 24&#xa0;months were 35% and 58%, respectively. At 24&#xa0;months, 51% of patients continued on CS, and 56% of patients experienced at least one CS side effect.</p> Conclusions <p>MMF and CYC had similar efficacy as initial therapies for pLN. RTX may augment long-term response. However, response rates were suboptimal. Large variations in initial therapy were observed. Given the paucity of prospective data in pLN, our study further illustrates the need for data-driven, pediatric-specific protocols to standardize care and improve outcomes.</p> Graphical Abstract <p></p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Clinical presentations, treatments, and outcomes of pediatric lupus nephritis: a prospective cohort study from the Pediatric Nephrology Research Consortium

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年5月11日

查看全文
  • Melonie Phillips,
  • Mahmoud Kallash,
  • Chloe Tang,
  • Steve Rust,
  • Kia Jubert-Bacon,
  • Scott Wenderfer,
  • Smriti Mohan,
  • Neal Blatt,
  • Don Batisky,
  • Alejandro Quiroga,
  • Tetyana L. Vasylyeva,
  • Nilka DeJesus,
  • Jerome C. Lane

摘要

Background

There are few prospective studies of mycophenolate mofetil (MMF) versus cyclophosphamide (CYC) for pediatric lupus nephritis (pLN) and none evaluating rituximab (RTX).

Methods

The Prospective Pediatric Lupus Nephritis Registry (ProPeL-R) enrolled patients < 21 years within 4 weeks of an initial kidney biopsy diagnostic of pLN. Demographic, clinical, and laboratory data were collected prospectively at enrollment, 3 months, 6 months, and then every 6 months thereafter for up to 5 years of follow-up. For this study, we compared patients receiving initial therapy with corticosteroids (CS) and either MMF (n = 33) vs. CYC (n = 18), and those treated with CS, either MMF or CYC, with RTX (n = 20) vs. without RTX (n = 51).

Results

Histology consisted of 18% class III; 35% class IV; 25% mixed class; and 22% pure class V. Eighty-two percent were female. No significant differences in response or infection rates were identified between those receiving MMF or CYC. There was a significant increase in combined complete (CR) and partial response (PR) at 24 months with RTX use. Overall CR rates at 6 and 24 months were 35% and 58%, respectively. At 24 months, 51% of patients continued on CS, and 56% of patients experienced at least one CS side effect.

Conclusions

MMF and CYC had similar efficacy as initial therapies for pLN. RTX may augment long-term response. However, response rates were suboptimal. Large variations in initial therapy were observed. Given the paucity of prospective data in pLN, our study further illustrates the need for data-driven, pediatric-specific protocols to standardize care and improve outcomes.

Graphical Abstract