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Abstract: FR-PO606

Comorbidities and Poor Long-Term Outcomes of Lupus Nephritis in Adult Patients in the United States

Session Information

Category: Glomerular Diseases

  • 1302 Glomerular Diseases: Immunology and Inflammation

Authors

  • Ayoub, Isabelle, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
  • Ma, Janice, Maple Health Group, New York, New York, United States
  • Pisarczyk, Konrad, Maple Health Group, New York, New York, United States
  • Leff, Richard, Kezar Life Sciences Inc, South San Francisco, California, United States
  • Park, Eunmi, Kezar Life Sciences Inc, South San Francisco, California, United States
  • Long, Li, Kezar Life Sciences Inc, South San Francisco, California, United States
Background

Lupus nephritis (LN) is a serious complication of systemic lupus erythematosus (SLE) associated with considerable morbidities, including but not limited to an increased risk of end-stage kidney disease (ESKD). There is a need to better understand clinical burden specific to LN. This study aimed to summarize evidence on long-term disease outcomes and comorbidities in adults with LN in the United States (US).

Methods

A comprehensive targeted literature review was conducted in MEDLINE and Embase to identify studies in patients with adult and juvenile onset of LN, published in English between March 2012 and 2022. The search included conference abstracts indexed in Embase since 2019.

Results

Of 4,216 records identified in the medical databases, 20 reported on long-term outcomes of disease and burden of comorbidities in adults with LN. The majority of studies were conducted on longitudinal cohorts and nationwide claims databases. Only 26% of LN adults achieved complete remission (CR) at 1 year and 40-59% achieved CR at 2 years, suggesting limited response to existing therapies. Those achieving CR after 2 years had a significantly lower mortality and ESKD risk compared with those who did not. LN adults suffered from hypertension (35-78%), cachexia (62%), serious infections requiring hospitalization (58%), and mental health disorders (29%). LN adults were more likely to experience cardiovascular (CVD) comorbidities compared to non-SLE, fractures compared to both non-SLE and SLE-only patients, and had 3-times higher odds of hospitalization due to posterior reversible encephalopathy syndrome compared to SLE-only adults. Causes of death were often CVD and serious infections requiring hospitalization. Deaths occurred in 20% of patients with serious infections requiring hospitalization with 49% of those occurring during hospitalization or up to 30 days after discharge. In LN-ESKD adults, 40% of patients died during follow-up, with CVD-related deaths as the most common (>40%) followed by infection-related deaths (14%).

Conclusion

LN is associated with poor long-term outcomes including increased risk of comorbidities compared to SLE only. Patients are often hospitalized or die due to comorbid CVDs and infections. There is a high unmet need for a therapy that can improve the long-term disease outcomes in LN.

Funding

  • Commercial Support