Effective use of rituximab in combination with low dose cyclophosphamide in childhood onset systemic lupus erythematosus (SLE) with relapsing class IV nephritis
Bibliographic record
Abstract
We evaluated effectiveness of rituximab, an anti-CD20 monoclonal antibody, in combination with low dose cyclophosphamide and intravenous (IV) methylprednisolone in three pediatric SLE patients with relapsing class IV nephritis. Identical twin females with SLE, complicated by biopsy proven class IV nephritis at age 6-years and treated with NIH cyclophosphamide protocol (NIHCP), had biopsy documented Class IV renal flare at age 10-years; unresponsive to mycophenolate mofetil (MMF) and corticosteroids. A 12-year old female with SLE, complicated by biopsy documented Class IV nephritis and treated with NIHCP, had 2 further renal flares, which responded to a cumulative dose of 36 grams of cyclophosphamide. At age 16, she had another biopsy documented class IV renal flare, despite maintenance with MMF. All patients received pulse therapy with: IV cyclophosphamide 0.5 g/m with IV methylprednisolone (IVMP) 250 mg on days 1 and 23; IV rituximab 375 mg/m on days 2, 9, 16 and 23. All 3 patients had a dramatic improvement in urine protein-creatinine ratios, and normalization of blood pressure. Despite low-dose daily corticosteroids, all patients had an increase in generalized SLE activity by 4 weeks following rituximab therapy, which responded to re-introduction of MMF. No side effects apart from expected decrease in B-cell counts were noted. Rituximab in combination with low dose cyclophosphamide and IVMP was effective in controlling recurrent class IV nephritis in 3 pediatric SLE patients. Re-introduction of mycophenolate mofetil was required within 4 weeks following rituximab therapy to maintain disease remission.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".