Objective To investigate the difference in the therapeutic effect of mycophenolate mofetil (MMF) or cyclophosphamide (CTX) in children with Henoch-Sch?nlein purpura nephritis (HSPN) of different age groups. Methods A retrospective analysis was conducted on the clinical data of 135 children with HSPN who were treated with MMF or CTX in the Department of Nephrology, Children's Hospital Affiliated to Capital Institute of Pediatrics, from October 2018 to October 2020. According to the immunosuppressant used, they were divided into two groups: MMF group and CTX group, and according to the age, each group was further divided into two subgroups: ≤12 years and >12 years, producing four groups, i.e, the ≤12 years MMF subgroup (n=30), the >12 years MMF subgroup (n=15), the ≤12 years CTX subgroup (n=71), and the >12 years CTX subgroup (n=19). All children were followed up for at least 12 months, and the above groups were compared in terms of clinical outcomes and the incidence rate of adverse reactions. Results There was no significant difference in the complete response rate between the MMF group and the CTX group after 3, 6, and 12 months of treatment (P>0.05). There were no significant difference in the complete response rate and the incidence rate of adverse reactions between the >12 years MMF subgroup and the ≤12 years MMF subgroup at 3, 6, and 12 months of treatment (P>0.05). The >12 years CTX subgroup had a significantly lower complete response rate than the ≤12 years CTX subgroup at 6 and 12 months of treatment (P<0.05). The >12 years CTX subgroup had a significantly higher incidence rate of adverse reactions than the >12 years MMF subgroup (P<0.05). Conclusions The efficacy and adverse reactions of MMF are not associated with age, but the efficacy of CTX is affected by age, with a higher incidence rate of adverse reactions. CTX should be selected with caution for children with HSPN aged >12 years.
Key words
Henoch-Sch?nlein purpura nephritis /
Cyclophosphamide /
Mycophenolate mofetil /
Therapeutic efficacy /
Child
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
References
1 Terano C, Hamada R, Tatsuno I, et al. Epidemiology of biopsy-proven Henoch-Sch?nlein purpura nephritis in children: a nationwide survey in Japan[J]. PLoS One, 2022, 17(7): e0270796. PMID: 35802668. PMCID: PMC9269900. DOI: 10.1371/journal.pone.0270796.
2 Namgoong M. Management of IgA vasculitis nephritis (Henoch-Schonlein purpura nephritis) in children[J]. Child Kidney Dis, 2020, 24(1): 1-13. DOI: 10.3339/jkspn.2020.24.1.1.
3 Jia Q, Ma F, Zhao J, et al. Effect of corticosteroids combined with cyclophosphamide or mycophenolate mofetil therapy for IgA nephropathy with stage 3 or 4 chronic kidney disease: a retrospective cohort study[J]. Front Pharmacol, 2022, 13: 946165. PMID: 36120326. PMCID: PMC9471000. DOI: 10.3389/fphar.2022.946165.
4 Zhou J, Tao MJ, Jin LR, et al. Effectiveness and safety of common therapeutic drugs for refractory lupus nephritis: a network meta-analysis[J]. Exp Ther Med, 2020, 19(1): 665-671. PMID: 31897105. PMCID: PMC6923745. DOI: 10.3892/etm.2019.8257.
5 Hackl A, Becker JU, K?rner LM, et al. Mycophenolate mofetil following glucocorticoid treatment in Henoch-Sch?nlein purpura nephritis: the role of early initiation and therapeutic drug monitoring[J]. Pediatr Nephrol, 2018, 33(4): 619-629. PMID: 29177628. DOI: 10.1007/s00467-017-3846-6.
6 中华医学会儿科学分会肾脏学组. 紫癜性肾炎诊治循证指南（2016）[J]. 中华儿科杂志, 2017, 55(9): 647-651. PMID: 28881507. DOI: 10.3760/cma.j.issn.0578-1310.2017.09.003.
7 邵宽芙蓉, 关凤军, 董晨. 白芍总苷辅助治疗儿童紫癜性肾炎的疗效及其机制探讨：前瞻性随机对照研究[J]. 中国当代儿科杂志, 2021, 23(1): 49-54. PMID: 33476537. PMCID: PMC7818153. DOI: 10.7499/j.issn.1008-8830.2008135.
8 程雪莲, 陈振辉, 包逢源. 丙种球蛋白联合雷公藤多苷治疗儿童过敏性紫癜性肾炎的效果及对尿蛋白、尿红细胞的影响[J]. 广东医学, 2020, 41(16): 1724-1728. DOI: 10.13820/j.cnki.gdyx.20191387.
9 田云粉, 汤春辉, 李平, 等. 吗替麦考酚酯联合激素治疗难治性过敏性紫癜疗效观察[J]. 中国医院药学杂志, 2020, 40(13): 1453-1457. DOI: 10.13286/j.1001-5213.2020.13.10.
10 Fan L, Yan H, Zhen X, et al. Safety and efficacy evaluation of traditional Chinese medicine (Qingre-Lishi-Yishen Formula) based on treatment of regular glucocorticoid combined with cyclophosphamide pulse in children suffered from moderately severe Henoch-Schonlein purpura nephritis with nephrotic proteinuria[J]. Evid Based Complement Alternat Med, 2020, 2020: 3920735. PMID: 32047523. PMCID: PMC7007748. DOI: 10.1155/2020/3920735.
11 刘娜, 马忠正, 严慧芳, 等. 双重血浆置换联合激素与免疫抑制剂治疗儿童重症紫癜性肾炎的临床效果[J]. 中国当代儿科杂志, 2019, 21(10): 955-959. PMID: 31642426. PMCID: PMC7389723. DOI: 10.7499/j.issn.1008-8830.2019.10.001.
12 Maritati F, Canzian A, Fenaroli P, et al. Adult-onset IgA vasculitis (Henoch-Sch?nlein): update on therapy[J]. Presse Med, 2020, 49(3): 104035. PMID: 32645417. DOI: 10.1016/j.lpm.2020.104035.
13 Peruzzi L, Coppo R. IgA vasculitis nephritis in children and adults: one or different entities?[J]. Pediatr Nephrol, 2021, 36(9): 2615-2625. PMID: 33219450. DOI: 10.1007/s00467-020-04818-7.
14 赵闻雨, 朱有华. 儿童肾移植受者的免疫抑制管理[J]. 器官移植, 2022, 13(3): 283-287. DOI: 10.3969/j.issn.1674-7445.2022.03.001.
15 汪靓雯, 邹新蓉, 王长江, 等. 雷公藤多苷治疗过敏性紫癜性肾炎随机对照试验的系统评价[J]. 中国中药杂志, 2018, 43(13): 2806-2816. PMID: 30111035. DOI: 10.19540/j.cnki.cjcmm.20180327.005.
16 Goswami RP, Sircar G, Sit H, et al. Cyclophosphamide versus mycophenolate versus rituximab in lupus nephritis remission induction: a historical head-to-head comparative study[J]. J Clin Rheumatol, 2019, 25(1): 28-35. PMID: 29561474. DOI: 10.1097/RHU.0000000000000760.
17 耿海云, 陈朝英, 李华荣, 等. 霉酚酸酯和环磷酰胺治疗儿童大量蛋白尿型过敏性紫癜性肾炎的前瞻性随机对照研究[J]. 中国当代儿科杂志, 2021, 23(4): 338-342. PMID: 33840404. PMCID: PMC8050539. DOI: 10.7499/j.issn.1008-8830.2012145.
PDF(518 KB)
