Lupus nephritis remission predicts long-term renal survival
Among patients with lupus nephritis, achieving renal remission 2 years after initial diagnosis is a significant predictor of long-term renal survival, according to findings published in the Journal of Rheumatology.
“Approximately 25% to 50% of systemic lupus erythematosus (SLE) patients develop clinically significant lupus nephritis and despite improvements in both diagnosis and treatment over the last few decades it remains an indicator of poor prognosis,” Beulah Ji, MD, a project physician leader for GlaxoSmithKline R&D, told Healio Rheumatology. “Clinical trials in lupus nephritis have been designed to demonstrate response to therapy based on various laboratory measures of renal function and activity, although definitions of renal response have varied across studies and the association between achieving a response and long term renal outcome is not established.”
To compare long-term renal survival among patients with lupus nephritis who achieved full, partial or no remission 2 years after receiving standard induction therapy, the researchers conducted an observational, retrospective analysis of data from the Hopkins Lupus Cohort prospective study. They identified 176 eligible patients with lupus nephritis, confirmed through biopsy, and categorized them based on whether they achieved complete, partial or no renal remission at 24 months. The patients were also grouped based on whether they responded to treatment.
Renal remission at 24 months was defined using the modified Aspreva Lupus Management Study (mALMS) and modified Belimumab International Lupus Nephritis Study (mBLISS-LN) criteria. The primary endpoint was long-term renal remission, defined as no end stage renal disease (ESRD) or death.
“The study was designed to address the evidence gaps around the long-term clinical utility of achieving partial or complete renal response at 24 months following lupus nephritis induction therapy,” Ji said.
According to the researchers’ regression models, and after adjusting for cofounders, patients who achieved complete remission at month 24 — based on either the mBLISS-LN (HR = 0.254; 95% CI, 0.082- 0.787; P = .0176) or mALMS (HR = 0.228; 95% CI, 0.063- 0.828; P = .0246) criteria — were significantly less likely to experience ESRD or mortality than who did not. Eighteen patients developed ESRD or died.
“The results show that patients who achieved complete or partial response were less likely to experience end stage renal disease or mortality than patients with no response,” Ji said. “The information may help inform trial design or decision making on patient monitoring and treatment, and therefore is considered relevant to physicians, regulators and payers.” – by Jason Laday
Disclosure: The researchers report funding from GlaxoSmithKline. Davidson reports being a shareholder and employee of GlaxoSmithKline at the time of the study, as well as a current employee of Eli Lilly and Company. See the full study for additional authors’ disclosures.