Abstract: FR-PO0819
Urine IP-10-Guided Preemptive Immunosuppression in Lupus Nephritis: A Multicenter Randomized Controlled Trial
Session Information
- Glomerular Clinical Trials: From Data to Impact
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Kittanamongkolchai, Wonngarm, Chulalongkorn University, Bangkok, Thailand
- Satirapoj, Bancha, Phramongkutklao Hospital, Bangkok, Thailand
- Ngamjanyaporn, Pintip, Mahidol University Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand
- Krisanapan, Pajaree, Thammasat University, Bangkok, Thailand
- Avihingsanon, Yingyos, Chulalongkorn University, Bangkok, Thailand
Background
Randomized trials assessing novel biomarkers to guide lupus nephritis (LN) treatment are limited. Urinary γ-interferon-inducible protein 10 (IP-10), a Th1-type chemokine involved in inflammatory cell recruitment, shows promise for detecting subclinical renal inflammation. This study evaluated whether urine IP-10–guided preemptive immunosuppression (pre-IST) reduces LN flare rates compared to standard care (SoC).
Methods
Patients with SLE and inactive LN from four tertiary hospitals in Bangkok, Thailand were monitored for urine IP-10 every 3 months for up to 24 months. Those with elevated urine IP-10 (≥3.37 log copies/μg total RNA) without an LN flare were randomized 1:1 to receive either SoC or pre-IST, consisting of prednisolone 20 mg/day tapered weekly to 5 mg/day. For patients already receiving mycophenolate mofetil (MMF) or azathioprine (AZA), doses were adjusted to 2000 mg/day and 1.5 mg/kg/day, respectively, for three months. Patients were followed quarterly to assess LN flares and adverse events (AEs).
Results
Among 93 enrolled patients (91% female, mean age 39.9 ± 9.7 years), 6 experienced LN flares before randomization; 2 had elevated urine IP-10 at flare onset. Ten patients had persistently negative urine IP-10 during follow-up; all were in complete remission (UPCI <500 mg/gCr), except one (UPCI 0.97 g/gCr). Seven discontinued immunosuppressives entirely, while 3 remained on minimal maintenance (AZA 50–100 mg/day or MMF 500 mg/day ± prednisolone ≤5 mg/day).
Seventy patients with elevated IP-10 but no flare were randomized (34 to SoC, 36 to pre-IST). LN flare rates were comparable between groups (18% in SoC vs. 14% in pre-IST; HR 0.81, 95% CI 0.25–2.66; p = 0.73). AE rates were also similar (IRR 1.12; p = 0.63).
Conclusion
Preemptive IST based on subclinical elevations in urine IP-10 did not reduce LN flare rates in patients with SLE. Conversely, persistently negative urine IP-10 may indicate quiescent disease and help guide safe tapering of immunosuppressive therapy.
Funding
- Government Support – Non-U.S.