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Abstract: FR-PO893

Tacrolimus Combined with Short-Term Corticosteroids for Inducing Remission in Membranous Lupus Nephritis: A Retrospective Study

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Wang, Yaomin, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
  • Han, Fei, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
Background

We retrospectively analyzed the efficacy of Tacrolimus combined with short-term corticosteroids for inducing remission in membranous lupus nephritis.

Methods

We retrospectively reviewed purely class V LN patients that were followed up in our center between January 2012 and December 2017. They were divided into 2 groups: IVC group received intravenous cyclophosphamide (0.75g/m2,once monthly) combining with prednisone (0.6-0.8mg/kg/d) and the dose of prednisone was gradually tapered after 8 weeks. Tacrolimus group received tacrolimus (trough serum concentration 6-8ng/ml) combining with a course of methylprednisolone impulse (8-10mg/kg/d, maximum 500mg/d, for 3 days), with or without following methylprednisolone 40mg/d; the total duration of corticosteroids was less than 2 weeks.

Results

Totally 65 patients with class V LN were analyzed, including 26 patients in IVC group and 39 patients in tacrolimus group. There were no significant differences on serum albumin, proteinuria, blood cells and immunological index at baseline between IVC and Tacrolimus group. Also, there were no significant differences on the severity of pathological changes such as glomerular sclerosis, crescent formation, mesangial proliferation, segmental necrosis and interstitial infiltrates between two groups. At 6 months, there were no significant differences on the remission rates between IVC group and tacrolimus group (80.8% vs 64.1%). The median follow-up time was 15.0 (10.5, 36.0) months in IVC group and 12.0 (6.0, 24.0) months in tacrolimus group (P=0.119). At the end of follow up, the remission rate (CR and PR) was significantly higher in IVC group than that in Tacrolimus group (92.3% vs 66.7%, P=0.045). There were 10 relapses including 3 (11.5%) relapses in IVC group and 7 (17.9%) relapses in tacrolimus group (P=0.369) at the end of follow up. Patients experienced less acne vulgaris in Tacrolimus group (10,25.6%) than IVC group (15,57.7%, P=0.010) and less Cushing syndrome in Tacrolimus group (5, 12.8%) than IVC group (13,50%, P=0.001).

Conclusion

Tacrolimus combined with short-term corticosteroids was as effective in short term but not as good in long term as intravenous cyclophosphamide combining with prednisone for inducing remission in membranous lupus nephritis, but with a tendency of fewer adverse effects.