EDITORIAL

Annals of Internal Medicine

Celebrating the ACP Centennial: From the Annals Archive

D

uring the 2015 centennial year of the American College of Physicians, publisher of Annals of Internal Medicine, the Annals editors will link an article in each issue with an earlier paper from our archives addressing the same disease or clinical question. We hope our readers find this interesting and we welcome comments, especially from physicians who were practicing at the time of publication of the original paper who might offer insight into the impact of the earlier paper on their knowledge or practice. In this issue, Liu and colleagues report the results of a randomized trial of multitarget therapy as induction therapy for lupus nephritis (1). Study participants received 3 days of pulse methylprednisolone followed by a tapering course of oral prednisone plus either tacrolimus and mycophenolate mofetil or cyclophosphamide. Steroid treatment of systemic lupus erythematosus began soon after the synthesis of these compounds in the 1940 but was only minimally effective in lupus nephritis. The development of additional immunosuppressive drugs led to attempts to improve outcomes in lupus nephritis by using combination therapy, such as in a clinical trial that Donadio and colleagues reported in Annals of Internal Medicine in 1972 (2).

This 1972 trial is notable for using randomization as well as a developing a scoring system for renal function and for the use of renal biopsy results as a surrogate marker of drug effect. Although the authors of this small trial concluded that addition of azathioprine to prednisone did not improve outcomes, subsequent studies found combination therapy to be superior and it became the standard of care. Deborah Cotton, MD, MPH Deputy Editor Ann Intern Med. 2015;162:70. doi:10.7326/M14-2654

References 1. Liu Z, Zhang H, Liu Z, Xing C, Fu P, Ni Z, et al. Multitarget therapy for induction treatment of lupus nephritis. A randomized trial. Ann Intern Med. 2015;162:18-26. doi:10.7326/M14-1030 2. Donadio JV, Holley KE, Wagoner RD, Ferguson RH, McDuffie FC. Treatment of lupus nephritis with prednisone and combined prednisone and azathioprine. Ann Intern Med. 1972;77:829-35. doi: 10.7326/0003-4819-77-6-829

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Celebrating the ACP centennial: from the Annals archive.

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