Review of the Outcome of the Treatment of Lupus Nephritis
with the Step-down Bridge Protocol of Intravenous and Oral
Combination of 5 Immunosuppressants
(SBP-5-IMNs)
Introduction
Drugs that have been used in the treatment of Lupus
Nephritis are NSAIDs, hydroxychloroquine, Azathioprine,
Cyclophosphamide, corticosteroids (Prednisone, Prednisolone,
and Methylprednisolone), Cyclosporine, and Mycophenolate
Mofetil. Myths are entrenched in the community, medical
professionals, and medical practitioners at large.
Treatment-free Remission has been reported by Drenkard et al
(23.4%), Darmawan J (85.5%), Ponticelli C, and Euler HH et
al in the treatment of Lupus Nephritis.
The consequences of previous low 5-years and 10-years
survival rate in Systemic Lupus Erythematosus (SLE) are that
myths are ingrained in the community, medical professionals
and practitioners, and even rheumatologists that SLE is a
potential mortal disease.
Myth No. 1
is Remission with whatever therapy is
impossible in Lupus Nephitis within months
Myth No. 2
is Remission by oral drugs is not possible
in Lupus Nephritis within months
Myth No. 3
is Remission without drug is unheard of in
Lupus Nephritis.
Myth No. 4
Histological Renal Remission (histological
normalization) in Lupus Nephritis is unheard of
Myth No. 5
Oral Corticosteroids such as Prednisone,
Prednisolone, and
Methylprednisolone are the standard drugs for SLE.
Myth No. 1
is refuted by the SBP-5-IMNs with
Remission achieved in 2-4 months
Myth No. 2
is refuted by the SBP-5-IMNs with
Remission with oral Drugs (RworalDs) achieved in 5.5-7.5
months
Myth No. 3
is refuted by the SBP-5-IMNs with
Remission without Drug (RwD) attained in 53.5-55.5 months
Myth No. 4
is refuted by the SBP-5-IMNs with reversal
of renal biopsy from WHO Class III-V to WHO Class I after 7
years.
How are these outcomes achieved? Click……
Myth No. 5 is refuted by the conclusion of the
following publication*.
*Gladman DD, Urowitz MB, Rahman P, Ibanez D, Tam LS. Accrual
of organ
damage over time in patients with systemic lupus
erythematosus. J Rheumatol.
2003 Sep;30(9):1955-9.
Conclusion of the above-listed paper:
Oral corticosteroid in the therapy of SLE is cumulatively
damaging to the kidneys. After > 15 years the renal damage
is mainly caused by long-term oral Prednisone or
Prednisolone or Methylprednisolone
Treatment with Mycophenolate Mofetil (Cellcept) May Become
First Line of Therapy for Lupus Nephritis. Source American
College of Rheumatology:
Clinical outcome
35 patients with Lupus Nephritis treated with the SBP-5-IMNs
in a 7 years observational study.
20 females with Lupus Nephritis, SLAM Score > 4, Chronicity
Index < 5, and ESR > 40 mm per 1 hour achieve with the
SBP-5-IMNs within 2-4 months, follow by
Remission with oral Drugs (RworalDs) in 5.5-7.5 months, and
ultimately
Remission without Drug (RwD) in 53.5-55.5 months after
initiation of the SBP-5-IMNs.
15 females with Lupus Nephritis, which has progressed to
Nephrotic Syndrome, Five dropouts, who have died within 2
years.
Ten patients improve from Nephrotic Syndrome to Lupus
Nephritis and achieves identical outcome as in Lupus
Nephritis.
Lupus Nephritis 1 and Nephrotic Syndrome 2 cases cannot be
tapered off oral drugs and remained in RworalDs until the
end of the study. Previously, these 3 cases have had
intermittent high dosages of pulse IV Methylprednisolone and
Cyclophosphamide abroad and are not IMN-naïve to
Methylprednisolone and Cyclophosphamide at presentation.
Not IMN-naïve patients, achieves only RworalDs and cannot
obtain RwD.
Histological outcome after 7 years
Renal histological reversal from WHO Class III-V to Class I
occurres in the 25 cases, but only IMN-naïve LN achieved
RwD.
Renal biopsy WHO Class I, II, do not require the SBP-5-IMNs
for treatment. Renal biopsy WHO Class VI is End Stage Renal
Disease, where treatment is useless.
With the addition of intravenous 5-Fluorouracil, the
SBP-5-IMNs becomes SBP-6-IMNs.
To suppress flare the SBP-6-IMNs is more effective with the
addition of intravenous 5-Fluorouracil (5FU), because of
IMN-naivety of 5FU, but with similar adverse effects.
Lupus Watch
The development of a potentially fatal irreversible
condition in SLE must be avoided or prevented
Multiple organs involvement of SLE with Lupus Nephritis plus
1 or more vital organs (Chronicity Index > 5) such as
Pulmonary Lupus, Cerebral Lupus (Neuropsychiatric SLE),
Central Lupus Vasculitis, and Lupus Avascular Osteonecroses
of the hip joint, progressivity of the disease can hardly be
terminated. It is common for the SLE and 1-2 non-vital
organ(s) to improve during therapy with the SBP-6-IMNs, but
the vital organ like the brain or longs do get worse. In not
IMN-naïve patient, it is common for therapy to fail in these
patients with a high mortality rate and low 5 and 10 years
survival rate.
Lupus Alert: do not let SLE progress to multiple
vital organs involvement with dubious prognosis, low 5 and
10 years survival rate.
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LupusArthritisIndonesia.org - Indonesian Lupus & Arthritis Forum
16.11.2005
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MabThera significantly improves symptoms in patients
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