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Abstract: FR-PO891

Ten-Year Outcome Differences in Lupus Nephritis Patients Treated with Cyclophosphamide and Mycophenolate-Based Treatment Regimen

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Prasad, Narayan, Sanja Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttarpradesh, India
  • Kurian, Jithu, Sanja Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttarpradesh, India
  • Agarwal, Vikas, Sanja Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttarpradesh, India
  • Gupta, Amit, Sanja Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttarpradesh, India
  • Bhadauria, Dharmendra, Sanja Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttarpradesh, India
Background

Lupus nephritis(LN) poses a considerable impact on the morbidity and mortality of SLE patients. Long term comparative outcome data with cyclophosphamide (CP) and mycophenolate mofetil (MMF) based regimen from the Indian subcontinent is sparse.

Methods

In the study, between July 2008 to June 2018, We analyzed outcomes of 100 LN patients( 26 class III, 25 class IV, 6 class III+V, and 10 class IV+V) ) treated with CYP (euro lupus-40 and NIH-27) and MMF-33 based regimen with the steroid. Class distribution of the patients in the two groups was similar. The renal survival and patients survival at the end of follow-up between two groups were compared.

Results

The clinical characteristics were similar in both groups, except activity index was high in CP patients (6.13 ±4.48 Vs 4.61 ± 2.80), however, chronicity index was similar. The overall remission was 70% at end of induction, CR, PR, and NR in the CP group was 46.2%, 23.9 %, 29.9% respectively; and in MMF group was 57.6%, 12.1%, and 30.3% respectively. In CP 14.9% and in MMF 9.1 % of patients died. The 1- ,2- ,3-, 4-, 5- and 10-years patient survival in the CP induction was 89.5% ,86.2%, 86.2%,83.8%, 83.8% and 83.8%; and in MMF was 93.9%, 93.9%, 89%, 89%, 89% and 89% respectively.The most common cause of death was sepsis 9/13(69.2%) followed by uremia. The high serum creatinine, low Hb, male, thrombocytopenia, microscopic haematuria, leucocyturia, nephrotic proteinuria, lack of remission at 12 months, dialysis, doubling of creatinine on follow-up were significant predictors of mortality.
The 1- ,2- 3-, 4-,5- and 10- years renal survival(event death-censored, but dialysis dependency) in CP group was 98.5%, 96.7%, 94.7%, 92.4%, 92.4% and 84 % respectively; and in the MMF was 96.8 %, 96.8%, 91.9%, 91.9%, 91.9%, and 78.8% respectively. At the end of the study, dialysis dependency in the MMF group and CYP group was 7.5% and 12.1 % respectively(NS).In the maintenance therapy, 3/56(5.3%) had doubling of creatinine in MMF,and 7/34 (20.5%) in the AZA group(p=0.03).

Conclusion

Long term outcomes in terms of patient and renal survival of LN patients treated with CP and MMF based induction is similar. Serum creatinine doubling was more with MMF than AZA based maintenance. Majority of death occurred during induction and sepsis was the most common cause of death.

Funding

  • Government Support - Non-U.S.