Evidence map›Paper›PMID 19297556›Full record

Trial reportJournal of the American Society of Nephrology : JASN2009

Randomized, controlled trial of prednisone, cyclophosphamide, and cyclosporine in lupus membranous nephropathy.

Howard A Austin, Gabor G Illei, Michelle J Braun, James E Balow

Open access · greenAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Journal of the American Society of Nephrology : JASN, 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 90 papers, 13 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
90citing papers in PubMed, 13 pooled it
17.1field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

90 citing papers in PubMed, 13 syntheses or guidelines pooled it, 295 citations in OpenAlex.

  1. Pooled it
  2. Guideline
  3. Guideline
  4. Pooled it
  5. Pooled it
  6. Pooled it
  7. Immunosuppressive treatment for proliferative lupus nephritis.The Cochrane database of systematic reviews · 2018
    Pooled it
  8. Pooled it
  9. Pooled it
  10. Pooled it
  11. Guideline
  12. Guideline
  13. Guideline
  14. Trial
  15. Article
  16. Article
  17. Review
  18. Review
  19. Not So Benign: Revisiting Pure Membranous Lupus Nephritis.Journal of personalized medicine · 2025
    Review
  20. Article

30 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

4 authors at 2 institutions in 1 country.

Howard A AustinKidney Disease Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Building 10, CRC 5-2551, Bethesda, Maryland 20892-1455, USA. howarda@bdg10.niddk.nih.gov
Gabor G Illei
Michelle J Braun
James E Balow
National Institute of Diabetes and Digestive and Kidney Diseases · USNational Institutes of Health · US

Funding

Clinical Investigations of Sjogren's SyndromeZIADE000704 · NIDCR · NATIONAL INSTITUTE OF DENTAL & CRANIOFACIAL RESEARCH · PI WARNER, BLAKE · 2009 to 2025
$22.3M
Immunosuppressive drug therapy in lupus membranous nephropathyZIADK043414 · NIDDK · NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES · PI BALOW, JAMES · 2009 to 2016
$2.5M
Immunosuppressive drug therapy in lupus membranous nephropathyZ01DK043414 · NIDDK · NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES · PI BALOW, JAMES · 2007 to 2008
$1.6M
Intramural NIH HHS
6 · The paper itself

Abstract

Patients with lupus membranous nephropathy (LMN) are at substantial long-term risk for morbidity and mortality associated with protracted nephrotic syndrome, including ESRD. The optimal treatment for this condition is controversial. Forty-two patients with LMN participated in a randomized, controlled trial to compare adjunctive immunosuppressive drugs with prednisone alone. Adjunctive regimens included either cyclosporine (CsA) for 11 mo or alternate-month intravenous pulse cyclophosphamide (IVCY) for six doses; the control group received alternate-day prednisone alone. Median proteinuria was 5.4 g/d (range 2.7 to 15.4 g/d). We assessed the primary outcome, time to remission of proteinuria during the 12-mo protocol, by univariate survival analysis. At 1 yr, the cumulative probability of remission was 27% with prednisone, 60% with IVCY, and 83% with CsA. Although both IVCY and CsA were more effective than prednisone in inducing remissions of proteinuria, relapse of nephrotic syndrome occurred significantly more often after completion of CsA than after IVCY. By multivariate survival analysis, treatment with prednisone and high-grade proteinuria (>5 g/d) but not race or ethnicity were independently associated with a decreased probability of remission. Adverse effects during the 12-mo protocol included insulin-requiring diabetes (one with prednisone and two with CsA), pneumonia (one with prednisone and two with CsA), and localized herpes zoster (two with IVCY). In conclusion, regimens containing CsA or IVCY are each more effective than prednisone alone in inducing remission of proteinuria among patients with LMN.

Indexed as

AdolescentAdultAge of OnsetCyclophosphamideCyclosporineFemaleHematocritHumansImmunosuppressive AgentsLupus NephritisMaleMiddle AgedPrednisonePrognosisProteinuriaSerum AlbuminCyclophosphamideCyclosporineImmunosuppressive AgentsPrednisoneSerum Albumin

Identifiers

PMID19297556
PMCPMC2663831
OpenAlexW2149686068

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.