Background Lupus nephritis (LN) is one of the major manifestations of systemic lupus erythematosus (SLE) which need aggressive immunosuppressive treatments.
Objectives The aim of this study was to investigate which therapeutic modalities were used for LN and whether response rate between therapeutics was different or not.
Methods One hundred sixth nine patients with LN on biopsy, who followed up more than at least 6 months after diagnosis, were included from multicenters in Korea between 2000 and 2010. We retrospectively analyzed the clinicopathologic data using WHO or ISN/RPS, therapeutics, and responses based on 2006 ACR remission criteria. Poor outcome was defined as chronic renal failure (GFR <60 ml/min), and death.
Results The mean age at the time of diagnosis of LN was 31.2 years and 41.1 months was followed. The proportion of class II, III, IV, and V was 14 (8%), 58 (34%), 63 (37%), and 34 (20%), respectively. Induction therapeutic modalities were different between classes of LN; the most common therapeutics for class IV was cyclophosphamide NIH regimen [CYC(NIH)] 50%, followed by mycophenolate mofetil (MMF) 33% and CYC Euro regimen [CYC(EUR)] 13%, in contrast to CYC(NIH) 41%, and azathioprine (AZA) 24% for class III, and cyclosporine(CS) 47%, and CYC(NIH) 21%] for class V. In addition, therapeutics for maintenance were also different between classes; MMF 42.2% and AZA 22% for class IV, AZA 43% and MMF 25% for class III, and CS 44% and MMF 20% for class V. Complete or partial response after induction therapy was achieved in 83%, 74%, and 79% of patients with class III, class IV, and class V, respectively. The response rate between induction therapeutics for LN classes was not significantly different. Poor outcome defined by chronic renal failure was observed in 4.1% (n=7) of patients, and was significantly associated with poor induction response (OR 30.1 [3.2-284.1]) and 1-year response (OR 16.0 [2.1-123.3]).
Conclusions Response to current therapeutics for each class of LN was favorable, regardless of therapeutic regimens. With appropriate induction therapy according to baseline renal function and histological class, remission to induction therapy was important factor for renal survival.
Disclosure of Interest None Declared
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