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Hooper and col eagues, therefore, investigated tacrolimus for 6 months, or for 9 months if com- the efficacy and tolerability of once-weekly plete remission was not achieved. Al patients 280 mg alendronate sodium taken as an oral also received intravenous methylprednisolone pulse therapy for the first 3 days of the study A total of 63 patients with PDB (mean age 69.3 years) were enrol ed at clinical centers in In intention-to-treat analyses, significantly Europe, North America, Australasia and Africa. more patients in the multitarget therapy group Participants received alendronate sodium in a than in the cyclophosphamide group achieved regimen of either a 40 mg/day tablet (n = 21) complete or partial remission at 6 months (18 or a 280 mg OBS once weekly (n = 42) for [90%] vs 9 [45%]; P = 0.002) and at 9 months 6 months; 52 patients completed the study (19 (19 [95%] vs 11 [55%]; P = 0.003). The overall in the tablet group, 33 in the OBS group). At incidence of adverse effects (e.g. gastro- 6 months, total serum alkaline phosphatase— a marker for PDB—decreased from baseline lower in the multitarget therapy group than in by 73% and 72% in the tablet and OBS treat- the cyclophosphamide group, although one ment groups, respectively. The incidence of patient in each group developed pneumonia.
non-serious adverse events was similar in both The authors conclude that this multitarget treatment groups, although more patients in therapy regimen is better at inducing remis- the 280 mg once-weekly group discontinued sion than is intravenous cyclophosphamide treatment because of adverse events than in patients with both diffuse proliferative and patients in the 40 mg once-daily group (19.0% membranous lupus nephritis. This efficacy could be due to the synchronous effects of The authors commented that, although the the different components of the multitarget two dosing regimens have similar efficacies, therapy on the different types of lesions in the 40 mg/day tablet was better tolerated. They did, however, add that “the potential for Original article Bao H et al. (2008) Successful treatment of improved esophageal safety of alendronate class V + IV lupus nephritis with multitarget therapy. J Am sodium 280 mg once-weekly OBS should not Soc Nephrol [doi:10.1681/ASN.2007121272] Original article Hooper M et al. (2008) Randomized, active-controlled study of once-weekly alendronate 280 mg high dose oral buffered solution for treatment of Paget’s disease. Osteoporos Int [doi:10.1007/s00198-008-0639-6] Etanercept is the only biologic agent approved for treating children with juvenile idiopathic nephritis with diffuse proliferative arthritis (JIA) who are over the age of 4 years with a disease course refractory to metho-trexate treatment. Data is lacking, however, on Patients with severe lupus nephritis who have the efficacy and safety of etanercept in patients both diffuse proliferative (class IV) and mem- younger than 4 years of age. Tzaribachev et al. branous (class V) lesions on biopsy can be have, therefore, performed an analysis of data refractory to current monotherapy treatments. on children in this subgroup from the German Bao et al. compared mycophenolate mofetil, tacrolimus and corticosteroid multitarget The study identified 25 patients under the treatment with cyclophosphamide in patients age of 4 years treated with etanercept (mean with class V + IV lupus nephritis in order to duration 19 months, range 1–54 months), determine an optimized immunosuppressive of whom 15 had systemic-onset JIA (soJIA) and 10 had nonsystemic JIA (nsJIA). Seven This Chinese, open-label study enrolled 40 patients with soJIA and nine with nsJIA met the patients with class V + IV lupus nephritis who were American Col ege of Rheumatology pediatric randomly al ocated to receive induction therapy response criteria for 70% improvement from with either intravenous cyclophosphamide baseline, while five children with soJIA and pulse therapy or mycophenolate mofetil and two with nsJIA achieved a complete response. NATURE CLINICAL PRACTICE RHEUMATOLOGY 507

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