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  • P92 Quantifying the unmet need in lupus nephritis: EULAR/ERA- EDTA treatment targets, flares, and treatment modifications in the first year in a multicenter observational study

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P92 Quantifying the unmet need in lupus nephritis: EULAR/ERA- EDTA treatment targets, flares, and treatment modifications in the first year in a multicenter observational study
  1. Maria Pappa1,
  2. Maria Kosmetatou2,
  3. Antigone Pieta3,
  4. Flora Chouzouri4,
  5. Evangelia Argyriou5,
  6. Christina Tsalapaki6,
  7. Aglaia Chalkia7,
  8. Theodoros Dimitroulas8,
  9. Mirto Cheila9,
  10. Georgios Demirtzoglou2,
  11. Charalampos Papagoras10,
  12. Andreas Goules11,
  13. Christina Katsiari12,
  14. Dimitrios Petras7,
  15. Dimitrios Vassilopoulos6,
  16. Prodromos Sidiropoulos4,
  17. Kyriaki Boki5,
  18. Petros P Sfikakis1,
  19. Paraskevi V Voulgari3,
  20. George K Bertsias4,
  21. Dimitrios T Boumpas2,
  22. Maria Tektonidou1 and
  23. Antonis Fanouriakis2
  1. 1Rheumatology Unit, First Dept. of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
  2. 2Rheumatology Unit, Fourth Dept. of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens, ‘Attikon’ University Hospital, Athens, Greece
  3. 3Rheumatology Clinic, Dept. of Internal Medicine, University Hospital of Ioannina, School of Health Sciences, Ioannina, Greece
  4. 4Rheumatology and Clinical Immunology, University of Crete, Medical School and University Hospital of Iraklio, Iraklio
  5. , Greece
  6. 5Rheumatology Unit, Sismanogleio General Hospital of Athens, Athens, Greece
  7. 6Clinical Immunology- Rheumatology Unit, 2 Dept. of Medicine and Laboratory, National and Kapodistrian University of Athens, General Hospital of Athens Hippokration, Athens, Greece
  8. 7Nephrology Dept., General Hospital of Athens Hippokration, Athens, Greece
  9. 8Fourth Dept. of Internal Medicine, Hippokration University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
  10. 9Rheumatology Clinic, Evangelismos General Hospital of Athens, Athens, Greece
  11. 10First Dept. of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
  12. 11Dept. of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
  13. 12Dept. of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University General Hospital of Larissa, Larissa, Greece

Abstract

Objective To decide on the optimal positioning of combination therapies in lupus nephritis (LN), we aimed to determine renal response rates with standard-of-care (SoC) treatment at 3, 6 and 12 months according to EULAR/ERA- EDTA treatment targets in real-life clinical practice.

Methods 135 patients with recent LN (2015- present) were included in a retrospective/prospective cohort study. Demographic, clinical, and laboratory data, as well as treatment at baseline and every 3 months were collected. Response rates in the first year according to EULAR/ERA-EDTA, flares, and use of glucocorticoids were calculated. Uni- and multivariate regression analysis was performed to assess determinants of renal flares during follow-up.

Results 135 patients were included, of whom 107 completed a 12-month follow-up [82.2% female, median (IQR) age 38 (22), 35.5% with nephrotic range proteinuria at diagnosis]. Histologically, 13.6% had class III, 36.4% class IV, 18.9% class V, and 28% mixed class LN (III/IV +V). With SoC therapy [initial treatment 54.1% cyclophosphamide (CYC), (9.8% received Euro-Lupus), 30.1% mycophenolic acid (MPA), followed by maintenance], 73%, 82.9% and 84.4% achieved EULAR/ERA-EDTA renal response rates at 3, 6 and 12 months, respectively. Patients treated with CYC differed significantly in histological parameters compared to MPA (table 1). All patients received IV methylprednisolone at baseline [median (IQR) 2.0 (2.0) gr]. In class IV LN, median (IQR) daily prednisone starting dose was 50.0 (20.0) mg/day, and at 6 months 10.0 (10.0) mg. In class III and V LN, median (IQR) daily starting doses were lower, 40.0 (32.0) mg and 30.0 (25.0), respectively, whereas at 6 months median (IQR) doses were equal, 10.0 (15) mg and 10.0 (7.5), respectively. 22 (20%) patients experienced a flare during the first 12 months of follow-up; 4 (18.2%) and 7 (31.8%) patients were added or switched to a different immunosuppressive drug, respectively. Level of proteinuria at baseline was associated with increased risk for flare in univariate analysis (OR 1.18, p=0.025).

Conclusions Although the majority of LN patients achieve a complete response by 12 months, a considerable proportion experience flares that necessitate treatment modification to reach this target.

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Abstract P92 Table 1
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ .

https://doi.org/10.1136/lupus-2024-el.146

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