EULAR heavy lupus research interpretation , biological agents to treat lupus nephritis future has come.

On June 6, the first phase of "MDT decoding lupus" activity planned and sponsored by physician daily was held.the meeting attracted more than 260000 people to watch online on the live broadcast platform of doctor's daily, the headline number of doctor's daily and Sina Weibo.Professor Yu Xueqing, President of Guangdong Provincial People's Hospital and chairman of the Congress, pointed out that lupus nephritis (LN) is an important complication of systemic lupus erythematosus (SLE).after several generations' efforts, great progress has been made in the treatment of LN, including remission rate and recovery. The therapeutic drugs have also been upgraded from hormone and cytotoxic drugs to current biological agents.recently, at the annual meeting of the European Union Against Rheumatism (EULAR), a high-quality global multicenter phase III study on the biological drug peleumab was included in the oral report, which showed its good therapeutic effect on LN.Professor Zhang Fengchun, chairman of the conference and director of the Department of internal medicine of Peking Union Medical College Hospital, introduced: "six years ago, a Northeast Asian Study of 500 patients with baileyumab also showed that the drug can reduce the double stranded DNA level and increase the complement level of lupus patients, and the symptoms of LN patients have been improved, and the hormone dose is reduced.with the increasing awareness of drugs by clinicians and patients, more patients will benefit. Professor Chen Wei, member of the Standing Committee and Deputy Secretary General of Nephrology branch of Chinese Medical Association and deputy director of Nephrology Department of the First Affiliated Hospital of Sun Yat sen University, Professor Chen Wei first introduced the bliss-ln study which was presented orally at the 2020 EULAR annual meeting.this study is the largest randomized controlled phase III study of active lupus nephritis in the world so far. The purpose of this study is to evaluate the efficacy and safety of baileyumab for injection in the treatment of active LN.Professor Yu Xueqing organized 15 centers in China to participate in the research and contributed 79 patients.this study is another key evidence for the treatment of active lupus nephritis with baileyumab, following three global multicenter phase III clinical studies bliss-52, bliss-76 and Northeast Asia studies.the study showed that at 104 weeks, more patients in the baileyumab + standard treatment group achieved the primary end point perR (43.0% vs. 32.3%, or: 1.55, 95% CI: 1.04-2.32, P = 0.0311).more patients in the baileyumab group reached the key secondary endpoint, and the differences were statistically significant.compared with the control group, the percentage of patients who achieved and maintained perR and CRR in the baileyumab group was higher, and the risk of kidney related events within 104 weeks in the baileyumab treatment group was significantly reduced.the safety of baileyumab was similar to that of placebo group.these two indicators are risk factors for lupus nephritis. Professor Zhang Fengchun suggested that antigen antibody binding complexes of SLE patients will deposit in the kidney, so the kidney is the most vulnerable organ of lupus erythematosus. Before the 1980s, the main cause of death in lupus patients was end-stage uremia.with the emergence of drugs, but due to the use of a large number of hormones and immunosuppressants, the survival period of SLE patients is prolonged, and infection becomes the first cause of mortality.the treatment goal of LN is to restore renal function, but 100% recovery is difficult, so it is very important to pursue maximum remission.Professor Yu Feng, director of the Department of Nephrology, Peking University International Hospital and director of scientific research and Education Department of Peking University International Hospital, said that due to the rich blood flow in the kidney, the proportion of lupus patients with renal involvement is very high. Pathologically, nearly 100% of lupus patients will have LN in their lifetime.the key node of the occurrence and development of LN is the formation of autoantibodies, including anti dsDNA antibodies and anti-C1q antibodies. In patients without ln symptoms, the early appearance of these two antibodies will increase the risk of renal involvement.during the clinical follow-up of lupus patients, renal function should be tested regularly. Besides glomerular filtration rate, renal tubular function should also be paid attention to, such as low specific gravity urine, unexplained hypokalemia, etc.Professor Ni Zhaohui, vice chairman of blood purification branch of China Hospital Management Association and director of Nephrology Department of Renji Hospital Affiliated to Shanghai Jiaotong University Medical College, said that compared with rheumatology department, lupus patients treated in nephrology department had more serious renal involvement, more critical diseases and more patients developed into end-stage renal failure.ln patients need to be treated by stages and stages, so that patients can achieve induced remission as soon as possible, which is very important for long-term prognosis.the main purpose of maintenance phase is to prevent recurrence and preserve long-term renal function.some clinical indicators are very important for judging renal function and recurrence, such as proteinuria, renal function, serum creatinine, glomerular filtration rate, etc.; SLE, such as complement, autoantibodies, etc.patients with lupus nephritis fear ln progression to end-stage renal failure. Professor Yu Qinghong, vice chairman of rheumatic immunology branch of Asia Pacific Medical Biological immunology society and director of Department of Rheumatology and immunology, Pearl River Hospital, Southern Medical University, said that lupus patients will have fear and worry about bad outcomes after diagnosis of lupus.at present, the treatment of lupus has achieved good results, but there are still many problems.the first is the residual activity of the disease; the second is recurrence; the third is the side effects of glucocorticoid use.how to achieve the goal of lupus treatment to minimize the side effects of treatment drugs, use the minimum amount of hormone or even stop using hormone are the common problems faced by lupus patients and doctors.bliss-52 / 76 / ln research and Northeast Asia research have given us great confidence. According to Professor Xu Gang, member of the Standing Committee of Nephrology branch of Chinese Medical Association and director of Nephrology Department of Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of science and technology, Professor Xu Gang said that about 10% - 30% of patients with proliferative ln will progress to end-stage renal failure, which depends on the severity of the disease, ethnic and economic factors, and treatment compliance.in recent ten years, the progress of drugs has greatly improved the overall prognosis of LN patients.ln patients entering dialysis have a high risk of death three months before dialysis, mainly due to secondary infection, adverse reactions caused by large doses of immunosuppressants, etc.renal transplantation can improve the survival of patients with end-stage renal failure caused by LN.the recurrence and renal damage of lupus patients can be judged according to laboratory indicators. baileyumab is effective in both induction and remission, and hormone reduction is a bright spot. Professor Ni Zhaohui introduced that the treatment course of lupus is very long, induction remission treatment and maintenance treatment need at least 9 months to 12 months or even longer, and the whole treatment takes about 2 years. In the bliss-ln study, baileyumab participated in the two treatment processes. in the induction treatment phase, baileyumab can rapidly inhibit B cell-related immune inflammation; in the maintenance treatment stage, baileyumab can support rapid hormone withdrawal to prevent disease recurrence. Professor Yu Feng said that in the latest version of the 2020 KDIGO guidelines, hormone reduction was also raised to the guidance level, and the research concept of bliss-ln was consistent with the requirements of the guidelines. Professor Chen Wei introduced that in bliss-ln study, compared with the traditional full dose regimen, the dosage of hormone was reduced rapidly. Taking the initial dose of 60 mg / D as an example, the hormone could be reduced to 2 capsules by the 12th week. rapid reduction reduced the adverse reactions of hormone. patients with type II and above ln should be treated with baileyumab as early as possible. Professor Sun Shiren, member of the Standing Committee of Nephrology branch of Chinese Medical Association and director of Nephrology Department of Xijing Hospital of Air Force Military Medical University, introduced that individualized treatment based on guidelines is very important. the treatment of LN patients includes non-specific treatment, such as hydroxychloroquine, RASI, and specific treatment, mainly hormones and immunosuppressants. the selection of hormones and immunosuppressants is often determined by pathological classification. type III and IV or type III + V, type III + V or type V usually have active lesions initially, which can be divided into induction phase treatment and remission phase treatment. the first-line regimen includes hormone + cyclophosphamide, hormone + mycophenolate mofetil (MMF), multi-target regimen, etc. sequential azathioprine regimen, MMF regimen and CNI can be used in the maintenance period. in addition, biological agents can be used to treat active lupus nephritis. Professor Li Ting, deputy leader of imaging group of Rheumatology and Immunology branch of Chinese Medical Doctor Association and deputy director of rheumatology department of South Hospital of Renji Hospital Affiliated to Shanghai Jiaotong University Medical College, Professor Li Ting said that three previous studies of baileyumab had been carried out. The reason why bliss-ln study was designed independently was that although the first three studies included about 16% of LN patients, they were not included in severe disease activities Ln patients in dynamic phase (proteinuria ≥ 6 g, creatinine significantly abnormal, etc.). the first three studies have observed that baileyumab has certain benefits for patients with renal involvement, so it is necessary to design a separate prospective study for LN patients, including patients with LN in the period of severe disease activity, to clarify the effectiveness and safety of drug treatment for LN, as well as the problem of drug use. Professor Chen Nan, chairman of the meeting, vice president of Nephrology branch of Chinese Medical Doctor Association, and Nephrology Department of Ruijin Hospital Affiliated to Shanghai Jiaotong University Medical College, the bliss-ln study showed that the complete remission rate was improved and the adverse reactions were low. for LN patients, the pathological type after renal biopsy is stage II. When mesangial cells proliferate, baileyumab can be used. If it is easy to treat, it is recommended to use it as soon as possible. please scan the QR code below for review of the meeting. Editor: Gui Jingfu reviewed by: Yin Han public email address for contribution to medical journal: yishibao2017@163.com [note] some of the pictures are from the network and wechat circle of friends. Dear Author, the doctor's Daily has prepared the contribution fee for you. Please contact the editor on duty at 58302828-6808 for past review A kind of What is the child thinking when you smoke? 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