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Abstract: FR-PO888

Histologic Findings from Paired Renal Biopsies: Single-Site Results from the ALLURE Study of Abatacept for Lupus Nephritis

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Malvar, Ana, Hospital Fernandez, Buenos Aires, Argentina
  • Alberton, Valeria Gabriela, Hospital Fernandez, Buenos Aires, Argentina
  • Recalde, Cecilia, Hospital Fernandez, Buenos Aires, Argentina
  • Gao, Sheng, Bristol-Myers Squibb, Princeton, New Jersey, United States
  • Maldonado, Michael, Bristol-Myers Squibb, Princeton, New Jersey, United States
Background

The optimal method for determining length of therapy for proliferative lupus nephritis (LN) is challenging. Discrepancies between clinical parameters and renal biopsies (Bx) remain. This is a post hoc analysis of repeat Bx and clinical outcomes from a single site in a study comparing abatacept (ABA) with placebo (PBO).

Methods

ALLURE (NCT01714817) is a PBO-controlled study in patients (pts) with active Class III or IV LN on mycophenolate mofetil/corticosteroids. We evaluated pts from a single site with repeat kidney Bx, which were classified by ISN/RPS and scored using National Institutes of Health activity index (AI) and chronicity index (CI). Findings were correlated with clinical outcomes.

Results

20/25 pts at the site had pre- and post-treatment (tx) Bx. Clinical characteristics and AI/CI scores were similar at baseline (Table). Four pts discontinued tx due to lack of efficacy (ABA n=1; PBO n=3). Most pts achieved urine protein to creatinine ratio (UPCR) ≤0.5 at least once during therapy (ABA 6/8; PBO 8/12); mean UPCR at Year 1 was lower in ABA arm (0.56 vs PBO 1.53). ABA group had lower 2nd Bx mean AI score (0.8 vs PBO 2.9). 6/8 from ABA group had an AI of 0 in 2nd Bx vs 5/12 in PBO group (Figure). Two PBO pts had UPCR ≤0.5 but had activity on 2nd Bx; two ABA pts without activity on 2nd Bx had UPCR >0.5 (0.6 and 0.8).

Conclusion

Repeat Bx in pts with LN after therapy can reveal tx-dependent discrepancies between clinical and histologic responses. Most patients treated with abatacept showed lack of activity. Better methodologies are needed to assess LN activity and improve clinical tx in pts with LN.
Writing assistance: Caudex.

Funding

  • Commercial Support