Outcome of Cyclophosphamide versus Mycophenolate Mofetil in Pediatrics Lupus Nephritis
Shimaa Sobhy Mohamed;
Abstract
S
ystemic lupus Erythematous (SLE) is an autoimmune S inflammatory disease characterized by antibodies directed against self-antigens, resulting in multi-organ damage. Up to 20% of cases are diagnosed during childhood with 55% of these patients are expected to develop lupus nephritis (LN). Lupus nephritis is the most frequent serious manifestation of SLE disease.
The introduction of corticosteroids and then immunosuppressive therapies, namely cyclophosphamide (CYP) and, more recently mycophenolate mofetil (MMF) have improved prognosis, such that 5-year survival rates are approximately 95%, and at 10- years 90%. Rates of end-stage renal failure (ESRF) remained static at 10–20% despite the effective therapies.
Practical treatment strategies vary according to the disease severity based on tissue specimens from renal biopsy as using the histological classification of LN by the International Society of Nephrology/Renal Pathology Society (ISN/RPS) 2003. This facilitates the selection of the treatment modality that is more effective and associated with less adverse reactions.
In general, currently available immunosuppressants for pediatric onset LN in clinical practice are the alkylating drug such as cyclophosphamide; antimetabolites, such as azathioprine, and mycophenolate mofetil; calcineurin inhibitors, such as cyclosporine and tacrolimus; and biologic treatment such as anti-CD20 antibody, rituximab.
ystemic lupus Erythematous (SLE) is an autoimmune S inflammatory disease characterized by antibodies directed against self-antigens, resulting in multi-organ damage. Up to 20% of cases are diagnosed during childhood with 55% of these patients are expected to develop lupus nephritis (LN). Lupus nephritis is the most frequent serious manifestation of SLE disease.
The introduction of corticosteroids and then immunosuppressive therapies, namely cyclophosphamide (CYP) and, more recently mycophenolate mofetil (MMF) have improved prognosis, such that 5-year survival rates are approximately 95%, and at 10- years 90%. Rates of end-stage renal failure (ESRF) remained static at 10–20% despite the effective therapies.
Practical treatment strategies vary according to the disease severity based on tissue specimens from renal biopsy as using the histological classification of LN by the International Society of Nephrology/Renal Pathology Society (ISN/RPS) 2003. This facilitates the selection of the treatment modality that is more effective and associated with less adverse reactions.
In general, currently available immunosuppressants for pediatric onset LN in clinical practice are the alkylating drug such as cyclophosphamide; antimetabolites, such as azathioprine, and mycophenolate mofetil; calcineurin inhibitors, such as cyclosporine and tacrolimus; and biologic treatment such as anti-CD20 antibody, rituximab.
Other data
| Title | Outcome of Cyclophosphamide versus Mycophenolate Mofetil in Pediatrics Lupus Nephritis | Other Titles | المقارنة بين السيكلوفوسفاميد والميكوفينوليت موفيتيل في علاج مرض الذئبة عند الأطفال | Authors | Shimaa Sobhy Mohamed | Issue Date | 2020 |
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