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
HAS 9 Education Outside the Classroom Education Outside the Classroom (EOTC) Safety Management procedures for Kapanui School Rationale • Children learn by safely experiencing and enjoying their environment. These experiences should be appropriate to their needs and prior experience. • Children should have the opportunity to explore the world safely outside the • E.O.T.C is defin
CAPÍTULO II GLOSARIO DE TÉRMINOS Definiciones: De acuerdo a la finalidad, contenido, uso y medio de emisión, se utilizan en el Manual de Procedimientos los siguientes términos, que serán explicados a continuación. Acto Administrativo: Es la ejercitación de la potestad administrativa que deriva del ejercicio, por parte de un órgano de la Administración Pública, de la