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Abstract: FR-PO1102

Comparison of Treatment Eras in a Large Cohort of Lupus Nephritis: Maintenance of Long Term Outcomes with Significantly Lower Burden of Immunosuppression and Corticosteroid Use

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Wilson, Hannah R., Imperial College London, Hammersmith Hospital, London, United Kingdom
  • Turner-Stokes, Tabitha, Imperial College London, Hammersmith Hospital, London, United Kingdom
  • Dasilva Santos, Iara, Fundacio Puigvert, BARCELONA, Spain
  • Griffith, Megan, Imperial College London, Hammersmith Hospital, London, United Kingdom
  • Levy, Jeremy B., Imperial College London, Hammersmith Hospital, London, United Kingdom
  • Cairns, Tom, Imperial College London, Hammersmith Hospital, London, United Kingdom
  • Cook, H. Terence, Imperial College London, Hammersmith Hospital, London, United Kingdom
  • Lightstone, Liz, Imperial College London, Hammersmith Hospital, London, United Kingdom
Background

Lupus Nephritis (LN) is a common & severe manifestation of systemic lupus erythematosus (SLE) requiring long courses of immunosuppression. Our lupus centre was established when 2 renal units merged in late 2005 & new protocols were developed focused on reducing the use of corticosteroids & increasing the use CD20+ B cell depletion therapy. We reviewed our large multi-ethnic cohort to assess the impact of these changes.

Methods

Demographic, clinical, histopathological & outcome data were reviewed for all patients with renal biopsies showing LN from 1/1/1996 to 1/1/2016. Patients treated 1996-2005 & 2006 onwards were compared. Data analysed per patient or per biopsy as appropriate.

Results

819 biopsies (151 pre 2006, 668 post 2006) were performed on 476 patients over the 20 years. 172 patients were diagnosed with LN pre 2006 & 302 post. Whilst there was no significant difference in patient gender or ethnicity between the eras, age at diagnosis was significantly different with a mean of 32 pre 2006 & 37 post 2006 (p<0.001). The baseline eGFR, urine protein creatinine ratio & dsDNA titres were not significantly different between the eras.

Conclusion

Treatment regimens have altered significantly post 2006 with a much greater use of anti CD20 therapy & a significant reduction in (high dose) CyP & prednisolone exposure for patients. Despite the significant reduction in the burden of immunosuppression, rates of response to treatment, flare & 10 year survival with preserved renal function have been maintained.