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  • O40 Impact of glucocorticoid dose on complete response, serious infections, and mortality during the initial therapy of lupus nephritis: a systematic review and meta-analysis of the standard of care arms of randomized controlled trials

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O40 Impact of glucocorticoid dose on complete response, serious infections, and mortality during the initial therapy of lupus nephritis: a systematic review and meta-analysis of the standard of care arms of randomized controlled trials
  1. Gabriel Figueroa-Parra1,
  2. María C Cuéllar-Gutiérrez1,2,
  3. Mariana González-Treviño1,
  4. Alain Sanchez-Rodriguez1,
  5. Jaime Flores-Gouyonnet1,
  6. José A Meade-Aguilar1,3,
  7. Larry J Prokop4,
  8. M Hassan Murad5,
  9. Maria Dall’Era6,
  10. Brad H Rovin7,
  11. Frédéric Houssiau8,
  12. Farah Tamirou9,
  13. Fernando C Fervenza10,
  14. Cynthia S Crowson1,11,
  15. Michael S Putman12 and
  16. Alí Duarte-García1
  1. *Co-primary authors, equal contribution
  2. 1Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA
  3. 2Division of Rheumatology, Hospital del Salvador, Santiago, Chile
  4. 3Dept. of Internal Medicine, Boston Medical Center, Boston, Massachusetts, USA
  5. 4Mayo Clinic Libraries, Mayo Clinic, Rochester, Minnesota, USA
  6. 5Evidence Based Center, Mayo Clinic, Rochester, Minnesota, USA
  7. 6Division of Rheumatology, University of California, San Francisco, California, USA
  8. 7Division of Nephrology, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
  9. 8Rheumatology Dept., Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique, Universite Catholique de Louvain, Brussels, Belgium
  10. 9Rheumatology Dept., Cliniques Universitaires Saint-Luc; Pôle de Pathologies Rhumatismales Inflammatoires et Systémiques, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
  11. 10Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
  12. 11Dept. of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
  13. 12Medical College of Wisconsin, Milwaukee, Wisconsin, USA

Abstract

Objective The recent EULAR SLE guidelines recommend the use of reduced GC regimens (0.3–0.5 mg/kg) in the treatment of LN. However, as they acknowledged, this is not evidence-based. Our objective was to evaluate the effect of different GC regimens with the standard of care therapy on renal response, infections, and mortality among patients with LN.

Methods We performed a systematic review and meta-analysis of the standard-of-care (SoC) arms of randomized clinical trials (RCTs) that used structured GC regimens. We searched in multiple databases from inception up to September 22, 2023. We included RCTs of biopsy-proven LN that used a protocolized scheme of GC in combination with mycophenolic acid analogs (MPAA) or cyclophosphamide and reported the outcomes of complete response (CR), serious infections, or death. We abstracted demographics and characteristics of the GC strategy: start dose of GC, taper scheme, and use of GC pulses. CR was defined as proteinuria <0.5 g/24hrs (or equivalent test) and stabilization of creatinine. We synthesized the estimates using proportional meta-analysis. We performed meta-regression to determine whether a linear relationship exists between the GC start dose and the rate of CR, serious infections, and death.

Results Out of 5,851 studies screened, 37 were included (3,231 patients; mean age 31.2 years; 88% female). A total of 50 individual RCT arms were suitable for meta-analysis. The rate of CR at six months in patients with LN treated with the SoC was 29.8% (95% CI 24.9–35.2%), and at twelve months was 33.9% (95% CI 27.8–40.7%). The meta-regression analysis showed a dose-response gradient between the starting GC dose and the rate of CR, serious infections, and death at six months (figure 1). The rates of CR and death increased with the use of pulses. The meta-regression at twelve months did not show an association with the starting GC dose and CR, infections, and death.

Conclusions Based on the findings of the present meta-analysis in patients with LN treated with the SoC and a structured GC regimen, there is an association between the starting GC dose and the rate of CR, serious infections, and death at six months.

Abstract O40 Figure 1
Abstract O40 Figure 1

Meta-regression predicted rates of (A) complete response, (B) serious infections, and (C) deaths at six months according to glucocorticoid start dose (mg/d) and use or not of GC pulses.

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.49

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