Uso da terapia Multi-Target em pacientes portadores de nefrite lúpica: avaliação de eficácia
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TCC
Data de publicação
2023-11-27
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Citações (Scopus)
Autores
Bernardo, Ana Luiza Fernandes
Izar, Fernanda Prehs
Izar, Fernanda Prehs
Orientador
Skare, Thelma Larocca
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Introdução: A nefrite lúpica (NL) é uma das complicações mais graves do lúpus eritematoso sistêmico (LES), doença autoimune sistêmica de difícil controle que danifica múltiplos tecidos e órgãos. Seu tratamento visa preservar a função renal e controlar a progressão da doença, evitando o encaminhamento para diálise ou transplante renal, sendo comumente utilizados glicocorticoides, micofenolato de mofetila (MMF) e ciclofosfamida como formas de tratamento padrão. Apesar dos avanços relativos ao conhecimento patogênico da doença, o atual tratamento convencional não proporciona uma boa eficácia clínica e apresenta altas taxas de recorrência e efeitos adversos. Desta forma, inibidores de calcineurina mostram-se como uma alternativa, como constituintes da terapia multi-target, que associa tacrolimus a MMF. No entanto, ainda existem poucos dados quanto à sua eficácia, efeitos adversos e tempo de uso. Objetivo: Este trabalho tem como objetivo analisar a taxa de resposta completa, resposta parcial, de falha terapêutica e a segurança da terapia multi-target em pacientes com nefrite lúpica, além de avaliar o tempo tolerado dos pacientes ao tratamento. Metodologia: Estudo retrospectivo feito por meio de análise retrospectiva de prontuários, através de uma revisão de prontuários de pacientes portadores de nefrite lúpica refratária que foram submetidos à terapia multi-target nos últimos 5 anos, com base em dados coletados entre fevereiro de 2023 e agosto de 2023 no Hospital Universitário Evangélico Mackenzie de Curitiba (HUEM), levando em consideração dados epidemiológicos, clínicos, laboratoriais e de efeitos colaterais observados durante o tratamento. Resultados: Foram analisados os prontuários de 24 pacientes. 87,5% deles eram do sexo feminino e a média de idade foi de 41,7 anos. As classes de nefrite predominantes foram GNF III e GNF IV. Dentre os achados laboratoriais, foi observada queda significativa no valor de proteinúria dos pacientes que usaram terapia multi-target, a média dela antes do tratamento de 0,83 g/24h e após de 0,3 g/24h (P-0,002). Ainda, verificou-se que, após uso do tratamento em estudo, houve uma redução significativa do uso de corticoide entre os pacientes, sendo que, dos 17 pacientes que faziam uso de prednisona antes da multi-target, apenas 7 continuaram usando após o novo tratamento. Quanto à remissão, dos 24 pacientes, 46% deles atingiu remissão completa, 29% atingiram remissão parcial, 17% obtiveram falha terapêutica e 8% não pôde ser avaliado por não ter atingido níveis séricos de tacrolimus. Conclusão: A terapia multi-target apresentou resultados satisfatórios para a redução de proteinúria dos pacientes com nefrite lúpica refratária, bem como para a redução do uso de corticosteroides, sendo benéfica para pacientes que experienciam efeitos colaterais graves da medicação esteroidal. Os resultados da terapia quanto a outros dados laboratoriais ainda necessitam, no entanto, de estudos futuros com amostras maiores para poderem ser discutidos.
Introduction: Lupus nephritis (LN) is one of the most severe complications of systemic lupus erythematosus (SLE), a systemic autoimmune disease that is difficult to control and damages multiple tissues and organs. Its treatment aims to preserve renal function and control the progression of the disease, thereby avoiding the need for dialysis or kidney transplantation. Commonly used treatments include glucocorticoids, mycophenolate mofetil (MMF), and cyclophosphamide as standard forms of treatment. Despite advancements in understanding the pathogenesis of the disease, current conventional treatment does not provide good clinical efficacy and is associated with high rates of recurrence and adverse effects. Thus, calcineurin inhibitors are emerging as an alternative, forming part of multi-target therapy, which combines tacrolimus with mycophenolate mofetil. However, there is limited data on their effectiveness, adverse effects, and duration of use. Objective: This study aims to analyze the rate of complete response, partial response, therapeutic failure, and safety of multi-target therapy in patients with lupus nephritis, as well as to assess the treatment duration tolerated by patients. Methodology: A retrospective study was conducted through the analysis of medical records, involving a review of the records of patients with refractory lupus nephritis who underwent multi-target therapy over the past 5 years. The data was collected between February 2023 and August 2023 at the Mackenzie Evangelical University Hospital in Curitiba (HUEM). The study considered epidemiological, clinical, laboratory, and observed side effects data during treatment. Results: Medical records of 24 patients were analyzed. 87.5% of them were female, with an average age of 41.7 years. The predominant nephritis classes were GNF III and GNF IV. Among the laboratory findings, a significant decrease in proteinuria levels was observed in patients receiving multi-target therapy, with an average of 0.83 g/24h before treatment and 0.3 g/24h after treatment (P-0.002). Additionally, after the use of the treatment under study, there was a significant reduction in corticosteroid use among patients. Among the 17 patients using prednisone before multi-target therapy, only 7 continued to use it after the new treatment. Regarding remission, of the 24 patients, 46% achieved complete remission, 29% achieved partial remission, 17% experienced therapeutic failure, and 8% could not be evaluated because they did not reach therapeutic tacrolimus serum levels. Conclusion: Multi-target therapy showed satisfactory results in reducing proteinuria in patients with refractory lupus nephritis, as well as in reducing the use of corticosteroids, which is beneficial for patients experiencing severe side effects of steroid medication. However, further studies with larger samples are required to discuss the therapy's outcomes concerning other laboratory data.
Introduction: Lupus nephritis (LN) is one of the most severe complications of systemic lupus erythematosus (SLE), a systemic autoimmune disease that is difficult to control and damages multiple tissues and organs. Its treatment aims to preserve renal function and control the progression of the disease, thereby avoiding the need for dialysis or kidney transplantation. Commonly used treatments include glucocorticoids, mycophenolate mofetil (MMF), and cyclophosphamide as standard forms of treatment. Despite advancements in understanding the pathogenesis of the disease, current conventional treatment does not provide good clinical efficacy and is associated with high rates of recurrence and adverse effects. Thus, calcineurin inhibitors are emerging as an alternative, forming part of multi-target therapy, which combines tacrolimus with mycophenolate mofetil. However, there is limited data on their effectiveness, adverse effects, and duration of use. Objective: This study aims to analyze the rate of complete response, partial response, therapeutic failure, and safety of multi-target therapy in patients with lupus nephritis, as well as to assess the treatment duration tolerated by patients. Methodology: A retrospective study was conducted through the analysis of medical records, involving a review of the records of patients with refractory lupus nephritis who underwent multi-target therapy over the past 5 years. The data was collected between February 2023 and August 2023 at the Mackenzie Evangelical University Hospital in Curitiba (HUEM). The study considered epidemiological, clinical, laboratory, and observed side effects data during treatment. Results: Medical records of 24 patients were analyzed. 87.5% of them were female, with an average age of 41.7 years. The predominant nephritis classes were GNF III and GNF IV. Among the laboratory findings, a significant decrease in proteinuria levels was observed in patients receiving multi-target therapy, with an average of 0.83 g/24h before treatment and 0.3 g/24h after treatment (P-0.002). Additionally, after the use of the treatment under study, there was a significant reduction in corticosteroid use among patients. Among the 17 patients using prednisone before multi-target therapy, only 7 continued to use it after the new treatment. Regarding remission, of the 24 patients, 46% achieved complete remission, 29% achieved partial remission, 17% experienced therapeutic failure, and 8% could not be evaluated because they did not reach therapeutic tacrolimus serum levels. Conclusion: Multi-target therapy showed satisfactory results in reducing proteinuria in patients with refractory lupus nephritis, as well as in reducing the use of corticosteroids, which is beneficial for patients experiencing severe side effects of steroid medication. However, further studies with larger samples are required to discuss the therapy's outcomes concerning other laboratory data.
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Palavras-chave
lúpus eritematoso , nefrite lúpica , terapia multi-target , tacrolimus , MMF , lupus erythematosus , lupus nephritis , multi-target therapy , tacrolimus , mycophenolate mofetil