ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on X

Kidney Week

Abstract: SA-PO974

The Use of Antimalarials in Lupus Nephritis Is Associated with Better Response to Therapy and Long-Term Kidney Survival

Session Information

Category: Glomerular Diseases

  • 1402 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Mejia-Vilet, Juan M., Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, CDMX, Mexico
  • Pena, Oscar, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, CDMX, Mexico
  • Macedo, Sofia E. Márquez, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, CDMX, Mexico
  • Juarez Cuevas, Bernardo, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, CDMX, Mexico
  • Pérez Arias, Abril A., Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, CDMX, Mexico
  • Zavala Miranda, Fernanda, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, CDMX, Mexico
  • Morales-Buenrostro, Luis E., Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, CDMX, Mexico
Background

The use of antimalarials (AM) in systemic lupus erythematosus (SLE) has been associated with lower disease flares and long-term damage accrual. Few studies have evaluated the effect of AM in lupus nephritis (LN) cohorts. We evaluated the association between AM use and response to therapy, LN flares, and long-term kidney survival in a large LN cohort.

Methods

The records of 424 patients with biopsy-proven LN were evaluated. We registered the dates of start and end of AM use, the type of AM (hydroxychloroquine [HCQ], chloroquine [CQ], or both), and the temporality of the AM initiation regarding the LN flare (previous and continued use, started at LN flare, or no use). The outcomes of complete response (CR), LN flare, kidney and patient survival were evaluated by uni and multivariable survival analyses.

Results

Out of 424 patients, 349 (82%) used an AM: 53 (13%) chloroquine, 282 (67%) hydroxychloroquine, and 36 (8%) used both AM at different times of follow-up. Of those taking AM, 195 (56%) had previous and continued use and in 154 (44%) the AM was started at flare. The time to CR was shorter in AM users than in non-users (log-rank p=0.009, Figure 1A). The incidence of LN relapses (p=0.017) and kidney failure (p<0.001) was lower in AM users (Figure 1B). The observations of better CR and lower incidence of LN flares and kidney failure with AM use were maintained when the data was analyzed according to the type of AM (HCQ or CQ) as well as the timing of use regarding the LN flare (previous and continued use or started at LN flare). The incidence of maculopathy was 1.2%, 5.9%, and 13.8% by 2-, 5-, and 10-years of AM use. There was no difference in the incidence of maculopathy between users of HCQ or CQ.

Conclusion

The use of AM in lupus nephritis is associated with better response to therapy, lower LN flares, and higher kidney survival. The rates of maculopathy are higher in LN cohorts than in general SLE cohorts.

Time to complete response (A) and kidney survival (B) according to the use of antimalarials.