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Kar Neng Lai - One of the best experts on this subject based on the ideXlab platform.
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efficacy of Mycophenolate Mofetil in patients with diffuse proliferative lupus nephritis hong kong guangzhou nephrology study group
The New England Journal of Medicine, 2000Co-Authors: Tak Mao Chan, Colin S O Tang, Raymond Woon Sing Wong, Guo Xiang Fang, C S Lau, Andrew K M Wong, Matthew K L Tong, Kwok Wah Chan, Kar Neng LaiAbstract:Background The combination of cyclophosphamide and prednisolone is effective for the treatment of severe lupus nephritis but has serious adverse effects. Whether Mycophenolate Mofetil can be substituted for cyclophosphamide is not known. Methods In 42 patients with diffuse proliferative lupus nephritis we compared the efficacy and side effects of a regimen of prednisolone and Mycophenolate Mofetil given for 12 months with those of a regimen of prednisolone and cyclophosphamide given for 6 months, followed by prednisolone and azathioprine for 6 months. Complete remission was defined as a value for urinary protein excretion that was less than 0.3 g per 24 hours, with normal urinary sediment, a normal serum albumin concentration, and values for serum creatinine and creatinine clearance that were no more than 15 percent above the base-line values. Partial remission was defined as a value for urinary protein excretion that was between 0.3 and 2.9 g per 24 hours, with a serum albumin concentration of at least 30 g per liter. Results Eighty-one percent of the 21 patients treated with Mycophenolate Mofetil and prednisolone (group 1) had a complete remission, and 14 percent had a partial remission, as compared with 76 percent and 14 percent, respectively, of the 21 patients treated with cyclophosphamide and prednisolone followed by azathioprine and prednisolone (group 2). The improvements in the degree of proteinuria and the serum albumin and creatinine concentrations were similar in the two groups. One patient in each group discontinued treatment because of side effects. Infections were noted in 19 percent of the patients in group 1 and in 33 percent of those in group 2 (P = 0.29). Other adverse effects occurred only in group 2; they included amenorrhea (in 23 percent of the patients), hair loss (19 percent), leukopenia (10 percent), and death (10 percent). The rates of relapse were 15 percent and 11 percent, respectively. Conclusions For the treatment of diffuse proliferative lupus nephritis, the combination of Mycophenolate Mofetil and prednisolone is as effective as a regimen of cyclophosphamide and prednisolone followed by azathioprine and prednisolone but is less toxic.
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efficacy of Mycophenolate Mofetil in patients with diffuse proliferative lupus nephritis
The New England Journal of Medicine, 2000Co-Authors: Tak Mao Chan, Colin S O Tang, Raymond Woon Sing Wong, Guo Xiang Fang, C S Lau, Andrew K M Wong, Matthew K L Tong, Kwok Wah Chan, Kar Neng LaiAbstract:Background The combination of cyclophosphamide and prednisolone is effective for the treatment of severe lupus nephritis but has serious adverse effects. Whether Mycophenolate Mofetil can be substituted for cyclophosphamide is not known. Methods In 42 patients with diffuse proliferative lupus nephritis we compared the efficacy and side effects of a regimen of prednisolone and Mycophenolate Mofetil given for 12 months with those of a regimen of prednisolone and cyclophosphamide given for 6 months, followed by prednisolone and azathioprine for 6 months. Complete remission was defined as a value for urinary protein excretion that was less than 0.3 g per 24 hours, with normal urinary sediment, a normal serum albumin concentration, and values for serum creatinine and creatinine clearance that were no more than 15 percent above the base-line values. Partial remission was defined as a value for urinary protein excretion that was between 0.3 and 2.9 g per 24 hours, with a serum albumin concentration of at least 3...
Mary Anne Dooley - One of the best experts on this subject based on the ideXlab platform.
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nonrenal disease activity following Mycophenolate Mofetil or intravenous cyclophosphamide as induction treatment for lupus nephritis findings in a multicenter prospective randomized open label parallel group clinical trial
Arthritis & Rheumatism, 2010Co-Authors: Ellen M Ginzler, David Wofsy, David A Isenberg, Caroline Gordon, Laura Lisk, Mary Anne DooleyAbstract:To assess the effect of Mycophenolate Mofetil compared with intravenous pulses of cyclophosphamide on the nonrenal manifestations of lupus nephritis.
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Mycophenolate Mofetil or intravenous cyclophosphamide for lupus nephritis
The New England Journal of Medicine, 2005Co-Authors: Ellen M Ginzler, Mary Anne Dooley, Cynthia Aranow, Mimi Kim, Jill P Buyon, Joan T Merrill, Michelle Petri, Gary S Gilkeson, Daniel J Wallace, Michael H WeismanAbstract:Background Since anecdotal series and small, prospective, controlled trials suggest that Mycophenolate Mofetil may be effective for treating lupus nephritis, larger trials are desirable. Methods We conducted a 24-week randomized, open-label, noninferiority trial comparing oral Mycophenolate Mofetil (initial dose, 1000 mg per day, increased to 3000 mg per day) with monthly intravenous cyclophosphamide (0.5 g per square meter of body-surface area, increased to 1.0 g per square meter) as induction therapy for active lupus nephritis. A change to the alternative regimen was allowed at 12 weeks in patients who did not have an early response. The study protocol specified adjunctive care and the use and tapering of corticosteroids. The primary end point was complete remission at 24 weeks (normalization of abnormal renal measurements and maintenance of baseline normal measurements). A secondary end point was partial remission at 24 weeks. Results Of 140 patients recruited, 71 were randomly assigned to receive myco...
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Mycophenolate Mofetil therapy in lupus nephritis clinical observations
Journal of The American Society of Nephrology, 1999Co-Authors: Mary Anne Dooley, Fernando G Cosio, Patrick H Nachman, Michael E Falkenhain, Susan L Hogan, Ronald J Falk, Lee A HebertAbstract:Controlled clinical trials in renal transplantation have demonstrated that Mycophenolate Mofetil is well tolerated and has lower renal transplant rejection rates than azathioprine regimens. This study reports on the clinical experiences at two institutions with Mycophenolate Mofetil (MMF) for severe lupus nephritis. Twelve patients with relapsing or resistant nephritis previously treated with cyclophosphamide therapy and one patient who refused cyclophosphamide as initial therapy for diffuse proliferative nephritis but accepted MMF were included. During combined MMF/prednisone therapy, serum creatinine values remained normal or declined from elevated values: mean change in serum creatinine was -0.26+/-0.46 microM/L, P = 0.039. Proteinuria significantly decreased: mean change in urine protein-to-creatinine ratios was -2.53+/-3.76, P = 0.039. Decreased serum complement component C3 and elevated anti-double-stranded DNA antibody levels at baseline improved in some, but not all, patients. The mean initial dose of MMF was 0.92 g/d (range, 0.5 to 2 g/d). The mean duration of therapy was 12.9 mo (range, 3 to 24 mo). Adverse events included herpes simplex stomatitis associated with severe leukopenia (n = 1), asymptomatic leukopenia (n = 2), nausea/ diarrhea (n = 2), thinning of scalp hair (n = 1), pancreatitis (n = 1), and pneumonia without leukopenia (n = 1). Recurrence of the pancreatitis led to discontinuation of MMF in this patient; all other adverse events resolved with dose reduction. It is concluded that MMF is well tolerated and has possible efficacy in controlling major renal manifestations of systemic lupus erythematosus. Controlled clinical trials are needed to define the role of MMF in the management of lupus nephritis.
Tak Mao Chan - One of the best experts on this subject based on the ideXlab platform.
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efficacy of Mycophenolate Mofetil in patients with diffuse proliferative lupus nephritis hong kong guangzhou nephrology study group
The New England Journal of Medicine, 2000Co-Authors: Tak Mao Chan, Colin S O Tang, Raymond Woon Sing Wong, Guo Xiang Fang, C S Lau, Andrew K M Wong, Matthew K L Tong, Kwok Wah Chan, Kar Neng LaiAbstract:Background The combination of cyclophosphamide and prednisolone is effective for the treatment of severe lupus nephritis but has serious adverse effects. Whether Mycophenolate Mofetil can be substituted for cyclophosphamide is not known. Methods In 42 patients with diffuse proliferative lupus nephritis we compared the efficacy and side effects of a regimen of prednisolone and Mycophenolate Mofetil given for 12 months with those of a regimen of prednisolone and cyclophosphamide given for 6 months, followed by prednisolone and azathioprine for 6 months. Complete remission was defined as a value for urinary protein excretion that was less than 0.3 g per 24 hours, with normal urinary sediment, a normal serum albumin concentration, and values for serum creatinine and creatinine clearance that were no more than 15 percent above the base-line values. Partial remission was defined as a value for urinary protein excretion that was between 0.3 and 2.9 g per 24 hours, with a serum albumin concentration of at least 30 g per liter. Results Eighty-one percent of the 21 patients treated with Mycophenolate Mofetil and prednisolone (group 1) had a complete remission, and 14 percent had a partial remission, as compared with 76 percent and 14 percent, respectively, of the 21 patients treated with cyclophosphamide and prednisolone followed by azathioprine and prednisolone (group 2). The improvements in the degree of proteinuria and the serum albumin and creatinine concentrations were similar in the two groups. One patient in each group discontinued treatment because of side effects. Infections were noted in 19 percent of the patients in group 1 and in 33 percent of those in group 2 (P = 0.29). Other adverse effects occurred only in group 2; they included amenorrhea (in 23 percent of the patients), hair loss (19 percent), leukopenia (10 percent), and death (10 percent). The rates of relapse were 15 percent and 11 percent, respectively. Conclusions For the treatment of diffuse proliferative lupus nephritis, the combination of Mycophenolate Mofetil and prednisolone is as effective as a regimen of cyclophosphamide and prednisolone followed by azathioprine and prednisolone but is less toxic.
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efficacy of Mycophenolate Mofetil in patients with diffuse proliferative lupus nephritis
The New England Journal of Medicine, 2000Co-Authors: Tak Mao Chan, Colin S O Tang, Raymond Woon Sing Wong, Guo Xiang Fang, C S Lau, Andrew K M Wong, Matthew K L Tong, Kwok Wah Chan, Kar Neng LaiAbstract:Background The combination of cyclophosphamide and prednisolone is effective for the treatment of severe lupus nephritis but has serious adverse effects. Whether Mycophenolate Mofetil can be substituted for cyclophosphamide is not known. Methods In 42 patients with diffuse proliferative lupus nephritis we compared the efficacy and side effects of a regimen of prednisolone and Mycophenolate Mofetil given for 12 months with those of a regimen of prednisolone and cyclophosphamide given for 6 months, followed by prednisolone and azathioprine for 6 months. Complete remission was defined as a value for urinary protein excretion that was less than 0.3 g per 24 hours, with normal urinary sediment, a normal serum albumin concentration, and values for serum creatinine and creatinine clearance that were no more than 15 percent above the base-line values. Partial remission was defined as a value for urinary protein excretion that was between 0.3 and 2.9 g per 24 hours, with a serum albumin concentration of at least 3...
Colin S O Tang - One of the best experts on this subject based on the ideXlab platform.
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Mycophenolate Mofetil alleviates persistent proteinuria in iga nephropathy
Kidney International, 2005Co-Authors: Sydney C W Tang, Colin S O Tang, Joseph Leung, Loretta Y Y Chan, Yun Hoi Lui, Chi Hang KanAbstract:Mycophenolate Mofetil alleviates persistent proteinuria in IgA nephropathy. Background Mycophenolate Mofetil (MMF) is increasingly used to treat primary glomerulopathies. Its effectiveness in IgA nephropathy (IgAN) remains unclear. Methods Forty IgAN patients with persistent proteinuria (>1 g/24 hours) despite conventional treatment with blockers of the renin-angiotensin system were randomized to receive MMF for 24 weeks (group 1) or continue conventional therapy (group 2), and followed for 72 weeks. The primary end point was reduction of proteinuria by 50% or more over entry level. Results Sixteen patients (80%) in group 1 versus six patients (30%) in group 2 reached the primary end point ( P = 0.0019). Time-averaged change in proteinuria showed a significant decline in group 1, while control subjects displayed a modest rise ( P = 0.003). By 72 weeks, the mean proteinuria was 62.0 ± 7.7% ( P = 0.003) and 120.5 ± 14.1% ( P = 0.351) that of the corresponding baseline value in group 1 and group 2, respectively. There was concomitant increase in serum albumin and decrease in serum IgA levels in group 1 but not group 2 patients. Baseline histologic grades, blood pressure control, and the rates of change in serum creatinine and creatinine clearance were not different between the two groups. Normalization in binding of polymeric IgA to cultured mesangial cells and serum interleukin-6 (IL-6) levels, which sustained to study end, was observed in group 1 but not group 2 subjects. Conclusion In selected patients with IgAN, MMF is effective in lowering proteinuria and ameliorating some of the putative pathogenetic abnormalities.
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efficacy of Mycophenolate Mofetil in patients with diffuse proliferative lupus nephritis hong kong guangzhou nephrology study group
The New England Journal of Medicine, 2000Co-Authors: Tak Mao Chan, Colin S O Tang, Raymond Woon Sing Wong, Guo Xiang Fang, C S Lau, Andrew K M Wong, Matthew K L Tong, Kwok Wah Chan, Kar Neng LaiAbstract:Background The combination of cyclophosphamide and prednisolone is effective for the treatment of severe lupus nephritis but has serious adverse effects. Whether Mycophenolate Mofetil can be substituted for cyclophosphamide is not known. Methods In 42 patients with diffuse proliferative lupus nephritis we compared the efficacy and side effects of a regimen of prednisolone and Mycophenolate Mofetil given for 12 months with those of a regimen of prednisolone and cyclophosphamide given for 6 months, followed by prednisolone and azathioprine for 6 months. Complete remission was defined as a value for urinary protein excretion that was less than 0.3 g per 24 hours, with normal urinary sediment, a normal serum albumin concentration, and values for serum creatinine and creatinine clearance that were no more than 15 percent above the base-line values. Partial remission was defined as a value for urinary protein excretion that was between 0.3 and 2.9 g per 24 hours, with a serum albumin concentration of at least 30 g per liter. Results Eighty-one percent of the 21 patients treated with Mycophenolate Mofetil and prednisolone (group 1) had a complete remission, and 14 percent had a partial remission, as compared with 76 percent and 14 percent, respectively, of the 21 patients treated with cyclophosphamide and prednisolone followed by azathioprine and prednisolone (group 2). The improvements in the degree of proteinuria and the serum albumin and creatinine concentrations were similar in the two groups. One patient in each group discontinued treatment because of side effects. Infections were noted in 19 percent of the patients in group 1 and in 33 percent of those in group 2 (P = 0.29). Other adverse effects occurred only in group 2; they included amenorrhea (in 23 percent of the patients), hair loss (19 percent), leukopenia (10 percent), and death (10 percent). The rates of relapse were 15 percent and 11 percent, respectively. Conclusions For the treatment of diffuse proliferative lupus nephritis, the combination of Mycophenolate Mofetil and prednisolone is as effective as a regimen of cyclophosphamide and prednisolone followed by azathioprine and prednisolone but is less toxic.
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efficacy of Mycophenolate Mofetil in patients with diffuse proliferative lupus nephritis
The New England Journal of Medicine, 2000Co-Authors: Tak Mao Chan, Colin S O Tang, Raymond Woon Sing Wong, Guo Xiang Fang, C S Lau, Andrew K M Wong, Matthew K L Tong, Kwok Wah Chan, Kar Neng LaiAbstract:Background The combination of cyclophosphamide and prednisolone is effective for the treatment of severe lupus nephritis but has serious adverse effects. Whether Mycophenolate Mofetil can be substituted for cyclophosphamide is not known. Methods In 42 patients with diffuse proliferative lupus nephritis we compared the efficacy and side effects of a regimen of prednisolone and Mycophenolate Mofetil given for 12 months with those of a regimen of prednisolone and cyclophosphamide given for 6 months, followed by prednisolone and azathioprine for 6 months. Complete remission was defined as a value for urinary protein excretion that was less than 0.3 g per 24 hours, with normal urinary sediment, a normal serum albumin concentration, and values for serum creatinine and creatinine clearance that were no more than 15 percent above the base-line values. Partial remission was defined as a value for urinary protein excretion that was between 0.3 and 2.9 g per 24 hours, with a serum albumin concentration of at least 3...
K Y Fong - One of the best experts on this subject based on the ideXlab platform.
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refractory immune thrombocytopenia in systemic lupus erythematosus response to Mycophenolate Mofetil
Lupus, 2003Co-Authors: S Vasoo, Julian Thumboo, K Y FongAbstract:Immune thrombocytopenia(IT) is a common manifestation of systemic lupus erythematosus (SLE). Although severe IT (< 20 ×10 9/L) occurs in about 5-10% of patients, usually in the context of active disease, the absence of randomized controlled trials has not allowed the development of evidence-basedguidelinesfor managing this condition.Conventionally, high-doseglucocorticoidsare consideredfirst-line therapy. Adjunctivemedical and surgical treatments for patients with an absent or partial response to glucocorticoids have met with varying degrees of success. We describe an SLE patient with IT refractory to high-dose corticosteroids, pulse methylprednisolone and intravenous immunoglobulin therapy, whose platelet counts normalized during therapy with Mycophenolate Mofetil (MMF). Pending further controlled studies to confirm this observation, we suggest that MMF may be considered as a therapeutic option in the treatment of glucocorticoid-refractory immune thrombocytopenia in SLE.
