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Abstract: PO1763

A Prospective Randomized Study on Preemptive Immunosuppressive Therapy in Lupus Nephritis Patients with Asymptomatic Serological Reactivation

Session Information

Category: Glomerular Diseases

  • 1202 Glomerular Diseases: Immunology and Inflammation

Authors

  • Yap, Desmond Yat Hin, University of Hong Kong, Hong Kong, Hong Kong
  • Lee, Paul, University of Hong Kong, Hong Kong, Hong Kong
  • Yam, Irene, University of Hong Kong, Hong Kong, Hong Kong
  • Chan, Tak Mao Daniel, University of Hong Kong, Hong Kong, Hong Kong
Background

The optimal management for asymptomatic serological reactivation (ASR) in lupus nephritis (LN) patients remains undefined. Our previous retrospective study suggested that pre-emptive moderate increase in immunosuppression may prevent subsequent clinical relapses.

Methods

We prospectively randomized LN patients with ASR (defined as >2-fold increase of anti-dsDNA to >100 IU/mL, with or without change in complement level, and absence of clinical lupus exacerbation) to receive pre-emptive treatment or unchanged management (‘Control’ group). Pre-emptive treatment included increasing prednisolone to 0.5 mg/kg/D, and the dose of mycophenolate to 1g/D or azathioprine to 75 mg/D, then tapered over 12-16 weeks back to the original dosages.

Results

Eighteen patients pre-emptive group and 17 in control group respectively). Pre-emptive group showed lower anti-dsDNA and higher C3 levels after 12 weeks compared with Controls (p<0.001, for both) (Figure 1). Pre-emptive group showed significantly lower incidence rates of all clinical relapses and renal relapse during subsequent 9 months follow-up compared with Controls (11.1% vs 41.2%, p=0.02; and 0% vs 17.6%, p=0.03; respectively). The pre-emptive group showed lower serum miR-148a compared with baseline value and also the Controls (p<0.001, for both). There was no clinically significant adverse event.

Conclusion

Our results suggest that pre-emptive moderate increase of immunosuppressive treatment reduces the risk of disease flare in LN patients with ASR and is well tolerated.

Figure1. Serial changes in (A) anti-dsDNA and (B) C3 levels in lupus nephritis with asymptomatic serological reactivation who have or have not reecieved pre-emptive immunosuppressive treatments.

Funding

  • Government Support - Non-U.S.