Abstract: FR-PO890
Efficacy of Cyclophosphamide and Mycophenolate Mofetil as Induction Immunosuppression in Proliferative Lupus Nephritis in Ethnic Minorities
Session Information
- Glomerular Diseases: Membranous Nephropathy, SLE, Complement
November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1203 Glomerular Diseases: Clinical, Outcomes, and Trials
Authors
- Wang, Qiyu O., John Stroger Jr. Hospital of Cook County, Chicago, Illinois, United States
- Solomon, Alfred T., John Stroger Jr. Hospital of Cook County, Chicago, Illinois, United States
- Xu, Jing, John H. Stroger Jr. Hospital, Chicago, Illinois, United States
- Joshi, Amit J., John Stroger Jr. Hospital of Cook County, Chicago, Illinois, United States
- Athavale, Ambarish, John Stroger Jr. Hospital of Cook County, Chicago, Illinois, United States
- Hart, Peter D., John Stroger Jr. Hospital of Cook County, Chicago, Illinois, United States
Background
Among patient with lupus nephritis, proliferative glomerulonephritis has the worst prognosis. Cyclophosphamide (CTX) and Mycophenolate mofetil (MMF) remain the preferred agents for induction immunosuppression in these patients. Some studies have suggested that MMF may be a superior induction agent among African American and Hispanics. We reviewed our experience in a predominant minority population.
Methods
A retrospective review of renal biopsy database from Jan 2011-March 2018 identified 50 patients with biopsy-proven class 3 or class 4 (±class 5) lupus nephritis with at least 6 months of follow-up. Baseline characteristics between the 2 treatment groups were compared using independent sample t-test for continuous variables, and Chi-square test for categorical variables. The KDIGO 2012 definition of remission criteria in lupus nephritis was used in assessing treatment response.
Results
The overall remission rate was similar between CTX and MMF group (64.2% vs 68.2%, p=0.773). There was a trend to use CTX in patients with class 4 lupus nephritis. African American patients were more likely to have crescents on kidney biopsy (65% vs 41%) and a lower response rate (52% vs 78%, P=NS). Tubular atrophy and interstitial fibrosis >25% was significantly associated with a lower response rate (OR= 3.01). Although 8 patients had positive antiphospholipid antibodies, thrombotic microangiopathy on kidney biopsy was noted in only one case. The response rate was lower in patients with positive antiphospholipid antibodies (37.5% vs 68.8%, P=NS).
Table 1: Demographic and clinical characteristics:
Conclusion
CTX and MMF are equally effective in inducing clinical remission in ethnic minorities with proliferative lupus nephritis. African American ethnicity, presence of crescents and higher tubular atrophy and interstitial fibrosis on renal biopsy was associated with lower response rate.