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THU0284 Health-Related Quality of Life in Patients with Proliferative Lupus Nephritis Treated with Short-Term High-Dose Intravenous Cyclophosphamide Followed by Mycophenolate Mofetil
  1. S. Arends1,
  2. J. H. Berden2,
  3. C. Grootscholten3,
  4. R. H. Derksen4,
  5. S. P. Berger5,
  6. R. G. de Sévaux2,
  7. A. E. Voskuyl6,
  8. M. Bijl on behalf of the Dutch Working Party on SLE7
  1. 1Rheumatology and Clinical Immunology, University Medical Center Groningen, Groningen
  2. 2Nephrology, Radboud University Nijmegen Medical Center, Nijmegen
  3. 3Internal Medicine and Gastroenterology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam
  4. 4Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht
  5. 5Internal Medicine, Erasmus MC, University Medical Center, Rotterdam
  6. 6Rheumatology, VU University Medical Center, Amsterdam
  7. 7Internal Medicine and Rheumatology, Martini Hospital Groningen, Groningen, Netherlands

Abstract

Background For decades, high-dose intravenous cyclophosphamide (ivCY) given for 24-30 months was regarded standard therapy for systemic lupus erythematosus (SLE) patients with proliferative lupus nephritis (LN). Previously, we showed that induction therapy with short-term (5 months) high-dose ivCY followed by mycophenolate mofetil (MMF) is as effective as long-term (24 months) high-dose ivCY in preventing renal relapses, end-stage renal disease, and mortality.(1)

Objectives The aim of the present analysis was to evaluate the effect of induction therapy with short-term high-dose ivCY followed by MMF on health-related quality of life (HRQoL).

Methods Between January 2003 and November 2006, 71 patients with biopsy-proven proliferative LN were included in the second Dutch LN Study. All patients were treated with ivCY (750 mg/m2, 6 pulses in 5 months) plus oral prednisone (OP; initially 1 mg/kg/day), followed by MMF (2000 mg/day) plus OP (10 mg/day) for 18 months, and then AZA (2 mg/kg/day) plus OP (10 mg/day) (CY/MMF group). HRQoL was assessed yearly with the Short Form-36 Health Survey (SF-36) and the SLE Symptom Checklist (SSC). Data were available for 62 of the 71 (87%) patients, with a median follow-up of 36 months (range 0-49). Results of the first 2 years were compared to the first Dutch LN Study, in which patients were treated with high dose ivCY (750 mg/m2, 13 pulses in 2 years) plus OP (initially 1 mg/kg/day) (CY group; n=50) or AZA (2 mg/kg/day) combined with iv methylprednisolone (3x3 pulses of 1000 mg) and OP (initially 20 mg/day) (AZA/MP group; n=37).(2) Generalized estimating equations (GEE) was used to analyze HRQoL over time within and between treatment groups.

Results Mean age of the 62 patients was 37.0 years (SD±11.4), 76% were female, and median time since diagnosis of SLE was 2 months (range: 0-16 years). The number of complaints and total distress level according to the SSC improved significantly during treatment. Fatigue (92%), painful joints (78%), and chubby cheeks/face (75%) were the most frequently reported complaints at baseline. The percentage of patients which reported to be fatigued decreased only slightly over time (85% after 4 years of treatment), while painful joints and chubby cheeks/face occurred less frequently during treatment (58% and 46% after 4 years, p<0.01). Six of the 8 domains of the SF-36 (physical functioning, role-physical, bodily pain, social functioning, role-emotional, and mental health) as well as the physical component summary improved significantly over time. No overall significant effect of treatment was found on vitality (p=0.068), general health (p=0.248), or the mental component summary (p=0.099). The course of HRQoL parameters during the first 2 years was comparable between the CY/MMF group and the CY and AZA/MP groups.

Conclusions This open-label study shows that induction therapy with short-term high-dose ivCY followed by MMF improves both general and disease-specific HRQoL in patients with proliferative LN.

References

  1. Arends S, et al. Ann Rheum Dis. 2012;71(Suppl3):540.

  2. Grootscholten C, et al. J. Rheumatol. 2007;34:1699-1707.

Disclosure of Interest None Declared

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