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Abstract: FR-PO895

Relapse Risk of Lupus Nephritis After Discontinuing Maintenance Mycophenolate

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Contreras, Gabriel, University of Miami, Miami, Florida, United States
  • Punchayil narayanankutty, Naveen, Jackson Memorial Hospital, Miami, Florida, United States
  • Madrid, Bianca, University of Miami, Miami, Florida, United States
  • Devi, Gayathri, Providence Hospital, Miami, Florida, United States
  • Duque, Juan Camilo, University of Miami, Miami, Florida, United States
  • Munoz Mendoza, Jair, University of Miami, Miami, Florida, United States
  • Sosa, Marie A., University of Miami, Miami, Florida, United States
  • Mithani, Zain, University of Miami, Miami, Florida, United States
  • Regis, Catarina, Jackson Memorial Hospital, Miami, Florida, United States
  • Philips, Ragi, Jackson Memorial Hospital, Miami, Florida, United States
  • Gonzalez Montalvo, Saul N., Jackson Memorial Hospital, Miami, Florida, United States
  • Vazquez Zubillaga, Luis Antonio, Jackson Memorial Hospital, Miami, Florida, United States
Background

Patients who achieved remission of lupus nephritis (LN) after induction immunosuppressive therapy are recommended to continue maintenance mycophenolate or azathioprine for at least three years.

Methods

In this study, we assessed the relapse risk of discontinuing mycophenolate after remission in 59 biopsy-proven LN patients on maintenance mycophenolate. Partial remission was defined as decreased urine protein/creatinine ratio (UPCR) <3 with prior nephrotic proteinuria or decreased UPCR ≤ 50% with sub-nephrotic proteinuria accompanied by improvement in or stabilization of creatinine (±25%). Complete remission was defined as UPCR <0.3 with creatinine <1.3 (in women) or <1.4 mg/dl (in men) and improved in the urine sediment. Relapse was defined as doubling of proteinuria (proteinuric) to UPCR > 1 from complete remission or > 2 from partial remission) or ≥50% increased creatinine.

Results

Patients who discontinued maintenance mycophenolate in <3 years compared with ≥3 years had similar baseline characteristics except for lower hematocrit (34 vs. 36%, p=0.026) and higher biopsy chronicity index (4 vs. 1 points, p=0.001). Discontinuing mycophenolate in <3 years compared with ≥3 years was significantly associated with relapse (adjusted hazard ratio of 3.56 [95% CL 1.33-9.54]) and shorter relapse free half-live of 3 years compared with 12 years.

Conclusion

Discontinuing maintenance mycophenolate prior to 3 years after remission of LN is significantly associated with relapse risk.