- ICH GCP
- Registro de ensayos clínicos de EE. UU.
- Ensayo clínico NCT07719140
Childhood-onset Lupus Nephritis Initial Glucocorticoid-dose Harmonization Trial (LIGHT Trial) (LIGHT)
Low- Versus High-Dose Initial Glucocorticoid Therapy for Childhood-Onset Proliferative Lupus Nephritis: a Multicenter Open-Label Noninferiority Randomized Controlled Trial
Childhood-onset systemic lupus erythematosus (cSLE) is a severe chronic autoimmune disease with a high burden of major-organ involvement. Lupus nephritis (LN) affects more than half of children with SLE, and proliferative LN-including class III, IV, III+V, and IV+V disease-is associated with acute kidney injury, progression to end-stage kidney disease, and poor long-term outcomes.
Glucocorticoids remain a cornerstone of induction therapy for proliferative LN. However, the optimal initial dose in children is uncertain. Although recent adult SLE and LN guidelines increasingly recommend lower-dose glucocorticoid regimens with rapid tapering, pediatric guidelines still commonly recommend high initial prednisone doses of 1.5-2.0 mg/kg/day. Adult trials and comparative observational studies suggest that lower-dose glucocorticoid regimens may preserve efficacy while reducing treatment-related toxicity.
Because cumulative glucocorticoid exposure in children may impair growth, development, psychosocial well-being, and medication adherence, this trial will compare low-dose versus high-dose initial glucocorticoid regimens for induction treatment of pediatric proliferative LN. The objective is to determine whether a lower-dose regimen is non-inferior in efficacy while reducing glucocorticoid-related adverse effects and improving quality of life.
Descripción general del estudio
Estado
Intervención / Tratamiento
Tipo de estudio
Inscripción (Estimado)
Fase
- Fase 4
Contactos y Ubicaciones
Estudio Contacto
- Nombre: Sihao Gao, MD, PhD
- Número de teléfono: 86-10-69155727
- Correo electrónico: sihao.gao@gmail.com
Ubicaciones de estudio
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Beijing Municipality
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Beijing, Beijing Municipality, Porcelana, 100730
- Reclutamiento
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences
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Contacto:
- Sihao Gao, MD, PhD
- Número de teléfono: 86-10-69155727
- Correo electrónico: sihao.gao@gmail.com
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Investigador principal:
- Hongmei Song, MD, PhD
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Beijing, Beijing Municipality, Porcelana
- Reclutamiento
- Beijing Children's Hospital, Capital Medical University
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Contacto:
- Huawei Mao, MD, PhD
- Número de teléfono: 86-10-59616318
- Correo electrónico: maohwei@qq.com
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Investigador principal:
- Huawei Mao, MD, PhD
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Chongqing Municipality
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Chongqing, Chongqing Municipality, Porcelana
- Aún no reclutando
- Chidren's Hospital of Chongqing Medical University
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Contacto:
- Xuemei Tang, MD
- Número de teléfono: 86-23-63630957
- Correo electrónico: tangxuemei2008@163.com
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Investigador principal:
- Xuemei Tang, MD
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Guangdong
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Shenzhen, Guangdong, Porcelana
- Aún no reclutando
- Shenzhen Children's Hospital
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Contacto:
- Jun Yang, MD
- Número de teléfono: 86-75-58395620
- Correo electrónico: rogasansz@163.com
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Investigador principal:
- Jun Yang, MD
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Hunan
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Changsha, Hunan, Porcelana
- Aún no reclutando
- The Second Xiangya Hospital of Central South University
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Contacto:
- Xiaochuan Wu, MD
- Número de teléfono: 86-731-85295259
- Correo electrónico: wuxiaochuan@sina.com
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Investigador principal:
- Xiaochuan Wu, MD
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Jiangsu
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Nanjing, Jiangsu, Porcelana
- Aún no reclutando
- Children's Hospital of Nanjing Medical University
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Contacto:
- Haiguo Yu, MD
- Número de teléfono: 86-25-83117830
- Correo electrónico: yuhaiguo73@126.com
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Investigador principal:
- Haiguo Yu, MD
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Jilin
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Changchun, Jilin, Porcelana
- Aún no reclutando
- Jilin University
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Contacto:
- Sirui Yang, MD
- Número de teléfono: 86-431-88783761
- Correo electrónico: sryang@jlu.edu.cn
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Investigador principal:
- Sirui Yang, MD
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Shanghai Municipality
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Shanghai, Shanghai Municipality, Porcelana
- Aún no reclutando
- Children's Hospital of Fudan University
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Investigador principal:
- Li SUN, MD
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Contacto:
- Li Sun, MD
- Número de teléfono: 86-21-64932829
- Correo electrónico: lillysun@263.net
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Criterios de participación
Criterio de elegibilidad
Edades elegibles para estudiar
- Niño
- Adulto
Acepta Voluntarios Saludables
Descripción
Inclusion Criteria:
- Age ≥6 years and <18 years, with body weight ≥20 kg
- Meets the 2019 European League Against Rheumatism (EULAR) and American College of Rheumatology (ACR) classification criteria for Systemic Lupus Erythematosus (SLE)
- Renal biopsy confirming Lupus Nephritis class III, IV, III+V, or IV+V according to the International Society of Nephrology / Renal Pathology Society (ISN/RPS) classification
- At screening: 24-hour urinary protein ≥1.0 g (or ≥25 mg/kg), or urine protein-to-creatinine ratio (UPCR) ≥1.0 g/g
- White blood cell count ≥3.0 × 10⁹/L and lymphocyte count ≥1.0 × 10⁹/L
- No prior intravenous methylprednisolone pulse therapy before enrollment, and glucocorticoid exposure ≤2 weeks before enrollment, with a maximum prednisone-equivalent dose ≤30 mg/day (or ≤1 mg/kg/day)
- Written informed consent obtained and good treatment compliance expected
Exclusion Criteria:
- Uncertain diagnosis of SLE, genetically confirmed monogenic lupus, or a history of immunodeficiency
- Severe infection, including hepatitis C, active hepatitis B, HIV infection, tuberculosis infection, severe fungal infection, etc.
- Severe neuropsychiatric lupus
- Peripheral blood hemoglobin <60 g/L, platelet count <10 × 10⁹/L, or concomitant aplastic anemia
- Severe cardiac insufficiency (NYHA functional class ≥ II)
- Severe pulmonary involvement, including pulmonary hemorrhage, respiratory failure, pulmonary embolism, or other conditions requiring respiratory support
- Estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m²
- Severe gastrointestinal bleeding, pancreatitis, or hepatic lesions
- Patients deemed by the investigator to be unsuitable for participation in this trial
Plan de estudios
¿Cómo está diseñado el estudio?
Detalles de diseño
- Propósito principal: Tratamiento
- Asignación: Aleatorizado
- Modelo Intervencionista: Asignación paralela
- Enmascaramiento: Ninguno (etiqueta abierta)
Armas e Intervenciones
Grupo de participantes/brazo |
Intervención / Tratamiento |
|---|---|
|
Comparador activo: Control group (High-dose group)
Standard high-dose glucocorticoid therapy
|
All participants will receive two courses of intravenous methylprednisolone pulse therapy (10-30 mg/kg/day for 3 consecutive days per course; maximum 500 mg/day). Participants will then be randomized in a 1:1 ratio to the two treatment groups. In the standard-dose (control) group, oral prednisone will be initiated at 1.4-1.6 mg/kg/day (maximum 60 mg/day), followed by gradual tapering according to the predefined schedule. For participants weighing <40 kg, doses will be adjusted in proportion to body weight using the following formula: Individual dose = standard dose × body weight (kg) × 0.025. All participants will receive background therapy with oral hydroxychloroquine, mycophenolate mofetil, and intravenous belimumab at standard doses. |
|
Experimental: Intervention group (Low-dose group)
Low-dose glucocorticoid therapy
|
All participants will receive two courses of intravenous methylprednisolone pulse therapy (10-30 mg/kg/day for 3 consecutive days per course; maximum 500 mg/day). Participants will then be randomized in a 1:1 ratio to the two treatment groups. Participants in the intervention group will receive oral prednisone at an initial dose of 0.6-0.8 mg/kg/day, with a maximum dose of 30 mg/day, followed by gradual tapering according to the predefined schedule. For participants weighing <40 kg, doses will be adjusted in proportion to body weight using the following formula: Individual dose = standard dose × body weight (kg) × 0.025. The estimated cumulative prednisone dose over 24 weeks will be approximately 50% of that in the control group. All participants will receive background therapy with oral hydroxychloroquine, mycophenolate mofetil, and intravenous belimumab at standard doses. |
¿Qué mide el estudio?
Medidas de resultado primarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
|---|---|---|
|
Total Renal Response at Week 24
Periodo de tiempo: Week 24
|
Total renal response (TRR) is defined as achievement of complete renal response (CRR), primary efficacy renal response (PERR), or partial renal response (PRR). Complete renal response (CRR) is defined as meeting both of the following criteria:
Primary efficacy renal response (PERR) is defined as meeting both of the following criteria:
Partial renal response (PRR) is defined as meeting both of the following criteria:
|
Week 24
|
Medidas de resultado secundarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
|---|---|---|
|
Complete Renal Response at Week 12 and 24
Periodo de tiempo: Week 12, 24
|
CRR is defined as meeting both of the following criteria: (1) Urine protein <0.5 g/1.73 m², or 24-hour urine protein <300 mg/m², or urine protein-to-creatinine ratio (UPCR) <0.5 g/g; AND (2) Estimated glomerular filtration rate (eGFR) within the normal range; or eGFR at least 85% of baseline; or normal serum creatinine with an increase of no more than 25% from baseline.
|
Week 12, 24
|
|
Primary Efficacy Renal Response at Week 12 and 24
Periodo de tiempo: Week 12, 24
|
PERR is defined as meeting both of the following criteria: (1) UPCR <0.7 g/g; AND (2) eGFR at least 80% of baseline or eGFR ≥60 mL/min/1.73
m².
|
Week 12, 24
|
|
Partial Renal Response at Week 12 and 24
Periodo de tiempo: Week 12, 24
|
PRR is defined as meeting both of the following criteria: (1) Urine protein reduced by ≥50% from baseline and UPCR <3 g/g; AND (2) eGFR at least 85% of baseline.
|
Week 12, 24
|
|
Time to TRR
Periodo de tiempo: Week 0-24
|
Total renal response (TRR) is defined as achievement of complete renal response (CRR), primary efficacy renal response (PERR), or partial renal response (PRR).
Complete renal response (CRR) is defined as meeting both of the following criteria: 1. Proteinuria <0.5 g/1.73 m², or 24-hour urinary protein excretion <300 mg/m², or urine protein-to-creatinine ratio (UPCR) <0.5 g/g; and 2. Estimated glomerular filtration rate (eGFR) within the normal range, or eGFR ≥85% of baseline, or a normal serum creatinine level with an increase of no more than 25% from baseline.
Primary efficacy renal response (PERR) is defined as meeting both of the following criteria: 1. UPCR <0.7 g/g; and 2. eGFR ≥80% of baseline or eGFR ≥60 mL/min/1.73
m².
Partial renal response (PRR) is defined as meeting both of the following criteria: 1.
A ≥50% reduction in proteinuria from baseline and UPCR <3 g/g; and 2. eGFR ≥85% of baseline.
|
Week 0-24
|
|
Time to CRR
Periodo de tiempo: Week 0-24
|
Complete renal response (CRR) is defined as meeting both of the following criteria: (1) Urine protein <0.5 g/1.73 m², or 24-hour urine protein <300 mg/m², or urine protein-to-creatinine ratio (UPCR) <0.5 g/g; (2) Estimated glomerular filtration rate (eGFR) within the normal range; or eGFR at least 85% of baseline; or normal serum creatinine with an increase of no more than 25% from baseline.
|
Week 0-24
|
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Time to PERR
Periodo de tiempo: Week 0-24
|
Primary efficacy renal response (PERR) is defined as meeting both of the following criteria: (1) UPCR <0.7 g/g; (2) eGFR at least 80% of baseline or eGFR ≥60 mL/min/1.73
m².
|
Week 0-24
|
|
Time to PRR
Periodo de tiempo: Week 0-24
|
Partial renal response (PRR) is defined as meeting both of the following criteria: (1) Urine protein reduced by ≥50% from baseline and UPCR <3 g/g; (2) eGFR at least 85% of baseline.
|
Week 0-24
|
|
Change of C3 from baseline to Week 24
Periodo de tiempo: Week 0, 24
|
To assess the improvement of SLE serum activity
|
Week 0, 24
|
|
Changes of C4 from baseline to Week 24
Periodo de tiempo: Week 0, 24
|
To assess the improvement of SLE serum activity
|
Week 0, 24
|
|
Change of anti-dsDNA titer from baseline to Week 24
Periodo de tiempo: Week 0, 24
|
To assess the improvement of SLE disease activity
|
Week 0, 24
|
|
Change of anti-dsDNA value from baseline to Week 24
Periodo de tiempo: Week 0, 24
|
To assess the improvement of SLE disease activity
|
Week 0, 24
|
|
Change of SLEDAI-2K from baseline to Week 24
Periodo de tiempo: Week 0, 24
|
To assess the level of disease activity improvement by Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) score.
|
Week 0, 24
|
|
Change of PGA from baseline to Week 24
Periodo de tiempo: Week 0, 24
|
Physician Global Assessment (PGA) is a clinical tool utilizing a 0 to 3 visual analogue scale to measure overall disease activity by experienced rheumatologists.
|
Week 0, 24
|
|
Change of ParentGA from baseline to Week 24
Periodo de tiempo: Week 0, 24
|
Parental Global Assessment (ParentGA) is a parent-reported outcome measure used to quantify a caregiver's perception of their child's overall disease impact and well-being.
ParentGA consists of a horizontal line containing 21 circles numbered from 0 to 10.
The scale moves in 0.5 increments.
The score of 0 indicates "very well" (best possible health status/disease activity) and 10 indicates "very poor" (worst possible health status/disease activity).
|
Week 0, 24
|
|
Change of PedsQL from baseline to Week 24
Periodo de tiempo: Week 0, 24
|
The Pediatric Quality of Life Inventory (PedsQL) is a modular assessment tool used to measure health-related quality of life in children, evaluating physical, emotional, social, and school functioning to generate an overall health score.
|
Week 0, 24
|
|
Change of serum creatinine from baseline to Week 24
Periodo de tiempo: Week 0, 24
|
To measure renal function levels
|
Week 0, 24
|
|
Change of eGFR from baseline to Week 24
Periodo de tiempo: Week 0, 24
|
eGFR (estimated Glomerular Filtration Rate) is a calculated value used to assess kidney filtration function. Pediatric eGFR [mL/(min·1.73m2)] = K × 88.4 × Height (cm)/Serum Creatinine (μmol/L). When serum creatinine is measured using the Jaffe method, the K coefficient is proportional to an individual's muscle mass and varies with age. In adolescents, it varies according to sex: Children and adolescent females: K = 0.55; Adolescent males: K = 0.77. When creatinine is measured using an enzymatic assay: K = 0.413 |
Week 0, 24
|
|
Change of 24-hour urine protein from baseline to Week 24
Periodo de tiempo: Week 0, 24
|
A 24-hour urine protein test measures kidney function by quantifying how much protein the body excretes in a full day.
|
Week 0, 24
|
|
Changes of UPCR from baseline to Week 24
Periodo de tiempo: Week 0, 24
|
A UPCR (Urine Protein Creatinine Ratio) test measures the amount of protein relative to creatinine in a single urine sample.
It is a highly accurate, convenient alternative to 24-hour urine test.
|
Week 0, 24
|
|
Rate of LN treatment failure at Week 24
Periodo de tiempo: Week 24
|
LN treatment failure is defined as the occurrence of any of the following:
|
Week 24
|
|
Rate of renal flare at Week 24
Periodo de tiempo: Week 24
|
Renal flare, defined by either (a) or (b):
|
Week 24
|
|
Rate of SLE flare at Week 24
Periodo de tiempo: Week 24
|
SLE flare is defined according to SELENA-SLEDAI definitions:
|
Week 24
|
|
Rate of LLDAS at Week 24
Periodo de tiempo: Week 24
|
LLDAS was defined as meeting all of the following criteria:
|
Week 24
|
|
Rate of DORIS remission at Week 24
Periodo de tiempo: Week 24
|
DORIS remission is defined as meeting all of the following criteria:
|
Week 24
|
|
PRINTO/ACR cSLE response rate at Week 24
Periodo de tiempo: Week 24
|
Response was defined as improvement of at least 50% from baseline in any two of the five core outcome measures, with no more than one of the remaining measures worsening by more than 30%. The five core outcome measures were Physician Global Assessment of overall disease activity (PGA), Parent Global Assessment of disease activity (ParentGA), proteinuria, the SLE Disease Activity Index 2000 (SLEDAI-2K), and the physical functioning domain of the Pediatric Quality of Life Inventory (PedsQL). |
Week 24
|
|
Changes of Childhood Lupus Improvement Index (CHILI) from baseline to Week 24
Periodo de tiempo: Week 0, 24
|
The Childhood Lupus Improvement Index (CHILI) is a validated measure of treatment response in childhood-onset SLE that primarily captures clinically meaningful improvement.
The score is calculated using five core outcome measures: Physician Global Assessment of overall disease activity (PGA), Parent Global Assessment of disease activity (ParentGA), proteinuria assessed by the urine protein-to-creatinine ratio (UPCR) or 24-hour urinary protein excretion, the SLE Disease Activity Index 2000 (SLEDAI-2K), and the physical functioning domain of the Pediatric Quality of Life Inventory (PedsQL).
(PMID: 30680946)
|
Week 0, 24
|
|
Rate of clinical, minor, moderate and major improvement in cSLE at Week 24
Periodo de tiempo: Week 0, 24
|
Using the CHILI absolute-change definition, clinical improvement is defined as a CHILI score ≥54; minor improvement as CHILI ≥15; moderate improvement as CHILI ≥68; and major improvement as CHILI ≥92.
|
Week 0, 24
|
|
Scores and changes of pGTI from baseline to Week 12 and 24
Periodo de tiempo: Week 0, 12, 24
|
The pediatric glucocorticoid toxicity index (pGTI) is a composite index including 10 glucocorticoid toxicity domains: body mass index, growth and development, glucose tolerance, lipid metabolism, systolic blood pressure, bone mineral density, glucocorticoid-induced myopathy, skin toxicity, neuropsychiatric effects, and infection. (PMID: 35917759) |
Week 0, 12, 24
|
|
SLICC/ACR Damage Index at Week 24
Periodo de tiempo: Week 24
|
The Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SLICC/ACR Damage Index, SDI) is designed to assess cumulative, irreversible organ damage occurring since the onset of SLE.
It encompasses 39 types of chronic, irreversible damage across 12 organ systems, irrespective of ongoing inflammatory disease activity.
(PMID: 8607884)
|
Week 24
|
|
Category, incidence and severity of adverse events
Periodo de tiempo: Week 0-24
|
Adverse events should be assessed at each study visit, including the event name, timing, management, severity, and outcome. Adverse event grading: Grade 1 (mild): Asymptomatic or mild symptoms; clinical or diagnostic findings only; no treatment required. Grade 2 (moderate): Requires minor or local treatment and limits instrumental activities of daily living. Grade 3 (severe): Medically significant but not immediately life-threatening; hospitalization may be required; limits self-care activities of daily living. Grade 4 (life-threatening): Requires urgent intervention. Grade 5 (death): Death related to the adverse event. |
Week 0-24
|
|
Change of blood pressure from baseline to Week 24
Periodo de tiempo: Week 0, 24
|
To measure improvement of kidney function, and monitor the side effect by glucocorticoids.
|
Week 0, 24
|
|
Change of fasting blood glucose from baseline to Week 24
Periodo de tiempo: Week 0, 24
|
To evaluate adverse events of glucocorticoids
|
Week 0, 24
|
|
Changes of serum triglycerides from baseline to Week 24
Periodo de tiempo: Week 0, 24
|
To monitor adverse effects of glucocorticoids
|
Week 0, 24
|
|
Changes of height from baseline to Week 24
Periodo de tiempo: Week 0, 24
|
To measure the growth velocity of children, and monitor the adverse events of glucocorticoids
|
Week 0, 24
|
|
Changes of bone marrow density from baseline to Week 24
Periodo de tiempo: Week 0, 24
|
To monitor the side effects of glucocorticoids, bone mineral density (BMD) is measured by dual-energy X-ray absorptiometry (DXA) at the lumbar spine.
|
Week 0, 24
|
Colaboradores e Investigadores
Patrocinador
Colaboradores
Investigadores
- Investigador principal: Hongmei Song, MD, PhD, Peking Union Medical College
Publicaciones y enlaces útiles
Publicaciones Generales
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- Dooley MA, Jayne D, Ginzler EM, Isenberg D, Olsen NJ, Wofsy D, Eitner F, Appel GB, Contreras G, Lisk L, Solomons N; ALMS Group. Mycophenolate versus azathioprine as maintenance therapy for lupus nephritis. N Engl J Med. 2011 Nov 17;365(20):1886-95. doi: 10.1056/NEJMoa1014460.
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- Kidney Disease: Improving Global Outcomes (KDIGO) Lupus Nephritis Work Group. KDIGO 2024 Clinical Practice Guideline for the management of LUPUS NEPHRITIS. Kidney Int. 2024 Jan;105(1S):S1-S69. doi: 10.1016/j.kint.2023.09.002. No abstract available.
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- Wang Y, Li X, Jian S, Li J, Yan J, Sun S, Yang Z, Zheng W, Li Q, Zheng Q, Lu M, Wang M, Yang Q, Mao H, Han T, Lin Y, Zhang Q, Du Y, Tang Y, Cai Y, Sun L, Zhang J, Liu J, Rong Z, Jiang L, Bai H, Chen Y, Yang J, Wang L, Zhang W, Wei X, Zhu Y, Li X, Xie X, Zhou D, Li Y, Cao Y, Shen T, Liu Q, Song H, Wu X; Chinese Alliance of Pediatric Rheumatic and Immunologic Diseases. Mycophenolate Mofetil versus Cyclophosphamide for Initial Therapy in Childhood-Onset Proliferative Lupus Nephritis: A Prospective, Multicenter, Randomized Trial. J Am Soc Nephrol. 2026 Mar 1;37(3):560-568. doi: 10.1681/ASN.0000000866. Epub 2025 Sep 12.
- Gong Y, Liu S, Liu H, Shi Y, Li Y, Guan W, Zeng Q, Lv Q, Zhang X, Wei Q, Chen J, Shen Q, Xu H, Sun L. Efficacy of initial combination with belimumab in newly diagnosed childhood-onset lupus nephritis: a single-centre historical control study. Lupus Sci Med. 2024 Dec 15;11(2):e001350. doi: 10.1136/lupus-2024-001350.
- Brogan P, Naden R, Ardoin SP, Cooper JC, De Benedetti F, Dicaire JF, Eleftheriou D, Feldman B, Goldin J, Karol SE, Price-Kuehne F, Skuse D, Stratakis CA, Webb N, Stone JH. The pediatric glucocorticoid toxicity index. Semin Arthritis Rheum. 2022 Oct;56:152068. doi: 10.1016/j.semarthrit.2022.152068. Epub 2022 Jul 14.
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Términos relacionados con este estudio
Palabras clave
Términos MeSH relevantes adicionales
- Enfermedades urogenitales
- Enfermedades urogenitales masculinas
- Enfermedades Renales
- Enfermedades urológicas
- Enfermedades urogenitales femeninas
- Enfermedades urogenitales femeninas y complicaciones del embarazo
- Enfermedades del tejido conectivo
- Enfermedades autoinmunes
- Enfermedades del sistema inmunológico
- Glomerulonefritis
- Nefritis
- Enfermedades de la piel y del tejido conectivo
- Lupus Eritematoso Sistémico
- Nefritis lúpica
- Compuestos policíclicos
- Espierra
- Embarazos
- Esteroides
- Compuestos de anillo fusionado
- Madreadiediols
- Prednisona
Otros números de identificación del estudio
- K10405
- 2025-PUMCH-C-047 (Otro número de subvención/financiamiento: National High Level Hospital Clinical Research Funding)
Plan de datos de participantes individuales (IPD)
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Descripción del plan IPD
Información sobre medicamentos y dispositivos, documentos del estudio
Estudia un producto farmacéutico regulado por la FDA de EE. UU.
Estudia un producto de dispositivo regulado por la FDA de EE. UU.
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