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Kidney Week

Abstract: SA-PO879

Long-Term Efficacy and Relapse in Lupus Nephritis Treated with Mycophenolate Mofetil and Tacrolimus Combination Therapy

Session Information

Category: Glomerular Diseases

  • 1402 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Imai, Yoichi, Gunma University Graduate School of Medicine Depatment of Nephrology and Rheumatology, Maebashi, Gunma, Japan
  • Ikeuchi, Hidekazu, Gunma University Graduate School of Medicine Depatment of Nephrology and Rheumatology, Maebashi, Gunma, Japan
  • Kinoshita, Masato, Gunma University Graduate School of Medicine Depatment of Nephrology and Rheumatology, Maebashi, Gunma, Japan
  • Suwa, Junya, Gunma University Graduate School of Medicine Depatment of Nephrology and Rheumatology, Maebashi, Gunma, Japan
  • Ohishi, Yuko, Gunma University Graduate School of Medicine Depatment of Nephrology and Rheumatology, Maebashi, Gunma, Japan
  • Watanabe, Mitsuharu, Gunma University Graduate School of Medicine Depatment of Nephrology and Rheumatology, Maebashi, Gunma, Japan
  • Nakasatomi, Masao, Gunma University Graduate School of Medicine Depatment of Nephrology and Rheumatology, Maebashi, Gunma, Japan
  • Hamatani, Hiroko, Gunma University Graduate School of Medicine Depatment of Nephrology and Rheumatology, Maebashi, Gunma, Japan
  • Sakairi, Toru, Gunma University Graduate School of Medicine Depatment of Nephrology and Rheumatology, Maebashi, Gunma, Japan
  • Kaneko, Yoriaki, Gunma University Graduate School of Medicine Depatment of Nephrology and Rheumatology, Maebashi, Gunma, Japan
  • Hiromura, Keiju, Gunma University Graduate School of Medicine Depatment of Nephrology and Rheumatology, Maebashi, Gunma, Japan
Background

Although recent research has shown the effectiveness of combination therapy with mycophenolate mofetil (MMF) and a calcineurin inhibitor for the initial treatment of active lupus nephritis (LN), its long-term outcomes still need to be explored.

Methods

We reviewed the medical records of 27 LN patients (4 males, 23 females) who underwent combination therapy with MMF and tacrolimus as an induction treatment from October 2009 to November 2018 in our department. Complete remission (CR) was defined by two criteria: 1) a urine protein to creatinine ratio (UPCR) of less than 0.5 g/gCr, and 2) a serum creatinine level (S-Cr) either normal or no more than 15% higher than the baseline. Both these criteria had to be met on two consecutive visits. A relapse was defined as a doubling of UPCR and ≥1.0 g/gCr on two consecutive visits or an intensification of immunosuppressive therapy after CR. Data are presented as median (IQR) or number (%).

Results

The median age was 38 (30-45) years, with 17 patients having new LN onset. Pre-treatment UPCR and eGFR were 4.21 (2.19-5.99) g/gCr and 62.6 (45.1-89.0) mL/min/1.73m2, respectively. Renal histology (ISN/RPS 2003) showed: Class III in 1, III+V in 4, IV in 13, IV+V in 8, and V in 1. CR rates at 6 and 12 months were 59% and 74%, respectively. The combination regimen was administered for 25 (5.5-37.0) months, and the total observation period was 94.0 (63.0-111.5) months. During this period, one patient died from heart failure. No patient reached end-stage kidney disease or experienced a doubling of S-Cr. Although 26 (96.3%) patients achieved CR in total, 16 (59.3%) patients experienced a relapse. Kaplan-Meier analysis revealed that chronic lesions (A/C) in renal biopsy and the absence of a low C4 level were associated with relapse (P=0.006 and P=0.0007, respectively, by Log-rank test).

Conclusion

Combination therapy for LN was effective in inducing CR and preserving renal function over a long-term period. However, patients with chronic histological lesions or the absence of a low C4 level were more likely to relapse.