Article Text
PDF
Abstract
Purpose Lupus nephritis (LN) is a severe manifestation of systemic lupus erythematosus (SLE), however, current treatment for LN is still associated with severe adverse effects, treatment failures, and relapse rates. Tacrolimus (TAC), a novel calcineurin inhibitor with immunosuppressive effects, has recently become increasingly interested in its role as a potential therapeutic agent in SLE. The aim of this study was to evaluate the efficacy of TAC as a treatment for LN.
Methods We retrospectively reviewed the medical records of patients with LN from January 1999 to December 2021. One-hundred seventy biopsy proven cases of LN were enrolled, with 92 in the TAC group and 87 in the non-TAC group. The clinical response of TAC treatment in patients with LN was evaluated by proteinuria, estimated glomerular filtration rate (eGFR), anti-double-stranded DNA (anti-dsDNA) antibody, complement 3 (C3), complement 4 (C4), and renal SLE disease activity index (SLEDAI). Complete renal response was defined as urine protein to creatinine ratio (UPCR) <0.5, normal serum creatinine or, if normal at baseline, not increased by ≥15%, and partial renal response was defined as a normal or near-normal GFR with a ≥ 50% reduction in proteinuria to sub-nephrotic levels. The poor outcomes were end stage renal disease or death.
Results The baseline clinical manifestations between the two groups showed no significant differences. Most of TAC group received combination therapy with other immunosuppressants, and only 19 (20.7%) patients maintained TAC monotherapy. After 5 years, there were no statistically significant differences in proteinuria, eGFR levels, anti-dsDNA, serum C3/C4, and renal SLEDAI. The overall (complete and partial) renal response rate was not significantly different: 72.9% of patients receiving TAC and 85.5% of patients not receiving TAC (p = 0.1). The poor outcomes were similar in both groups.
Conclusions Our results indicate that TAC is potentially effective in treating LN, and may be a reasonable option for patients with LN. TAC can help patients with LN achieve a renal response and slow progression.
Kaplan-Meier plot of remaining free of poor-outcomes in patients with lupus nephritis
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/.