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Abstract: TH-PO489

Repeat Kidney Biopsy Findings of Lupus Nephritis Patients in Clinical Remission Treated With Mycophenolate Associated With Belimumab or Mycophenolate Plus Standard of Care Therapy

Session Information

Category: Glomerular Diseases

  • 1303 Glomerular Diseases: Clinical‚ Outcomes‚ and Trials

Authors

  • Malvar, Ana, Hospital Fernandez, Buenos Aires, Argentina
  • Alberton, Valeria Gabriela, Hospital Fernandez, Buenos Aires, Buenos Aires, Argentina
  • Recalde, Cecilia, Hospital Fernandez, Buenos Aires, Argentina
  • Davila Terreros, Pedro Jose, Hospital Fernandez, Buenos Aires, Buenos Aires, Argentina
  • Heguilen, Ricardo M., Hospital Fernandez, Buenos Aires, Buenos Aires, Argentina
Background

Early and intensive treatment of Lupus nephritis determines an accelerated decrease in inflammation and, subsequently, reduces the extent of tissue that progresses to scarring and future renal failure. Addition of Belimumab to standard of care treatment showed to increase the possibility of achieving a complete kidney response with less renal events during follow up. The aim of this study was to assess the “post hoc" analysis of the clinical and histological differences between patients enrolled in the BLISS LN trial (BLNT) in a single center

Methods

All the participants (20, one male) had an initial renal biopsy (Bx1), used at screening for the BLNT and fulfilled the trial satisfactorily. Once the BLNT and the Open Label Extension (OLE) were finished, they continued to receive mycophenolate (MMF) and concomitant medications. Mean follow up was 70,7 ( ± 8,2 months).
All the patients were re- biopsied (Bx2) either if they presented a flare or after a minimum period of 36-month with at least 12 months of Complete Clinical Response (CCR) so as to assess inactivity. CCR was defined as proteinuria ≤ 500 mg/d and eGFR > 60 ml/min/m2 and eGFR > 60 ml/min/m2 with no decrease of > 20% from baseline (BLNT randomization). Complete Histological Remission (CHR) was defined as an activity index = 0 at Bx2. NIH activity (AI) and chronicity (CI) indices, CCR, CHR and the occurrence of flares in each arm were compared.

Results

Clinical and histological data are shown in the Table. AI and CI are presented as median (SD).

Conclusion

Though the small number of patients the arm treated with MMF plus belimumab seemed to achieve more frequently a complete histological and clinical response with lower CI in the Bx2 and fewer relapses during treatment and long follow up.
(Statistical analysis was not done due to the small sample)

Arm TreatmentCCR Bx2
(n)
CHR Bx2
(n)
AI Bx1AI Bx2CI Bx1CI Bx2Flares
(n)
MMF + Placebo
(n=10)
757,6 (4,1)2,7 (3,8)2,1 (1,9)4,5 (2,4)2
MMF + Belimumab
(n=10)
1095,8 (4,5)0,4 (1,3)1,6 (1,9)3,5 (1,0)0

Funding

  • Private Foundation Support