Multitarget Therapy for Induction Treatment of Lupus Nephritis: A Randomized Trial
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Multitarget Therapy for Induction Treatment of Lupus Nephritis: A Randomized Trial. Ann Intern Med.2015;162:18-26. [Epub 6 January 2015]. doi:10.7326/M14-1030
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The authors declare no potential conflict of interest.
1. 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., 2014, Multitarget Therapy for Induction Treatment of Lupus Nephritis: A Randomized, Controlled Trial, Annals of internal medicine.
Alexandre Braga Libório*
Dulce Maria Silva Barreto#
* Professor, Clinical Medicine Department, Universidade Federal do Ceará,
# Chief of Glomerulopathy Section, Nephrology service, Hospital Geral de Fortaleza.
Comment on Multitarget therapy in Lupus Nephritis
As this study stopped including patients 3,5 years ago, it is of highly interest for the practicing clinician to know what maintenance therapy was given. We know from kidney transplantation literature that calcineurin-induced (CNI) nephrotoxicity was found in 25% of patients after 24 weeks, 33% after 1 year and almost 100% after 10 year (NEJM 2003;349:2326). Because the authors were able to analyse 23 repeat biopsies, it would be interesting to establish microscopic signs of CNI nephrotoxicity which would explain the lower eGFR in the multitarget treatment group.
Whether multitarget therapy is really superior to high dose cyclophosphamide will need to be proven when further follow-up of the study is shared. The present study was designed as a non-superiority trial with an estimated power of 80% and the hypothetical power of superiority of multitarget therapy was not calculated. From a statistical point of view, there was a 14% drop-out in each group which was not reflected in the statistical non-responder analysis. Despite this, the present study shows very promising results and definitely warrants further study in a general (non-Asian) lupus nephritis population. Because the follow-up was short, and, as with any successful induction therapy in lupus nephritis, two questions remain unsolved: how long and how intense should this therapy be given in order to achieve long-term remission without cumulative side-effects?