Study Evaluates Medications for Long-Term Maintenance Therapy in Lupus Nephritis
New study results presented at the Annual European Congress of Rheumatology show that individuals with lupus nephritis (LN) on long-term maintenance therapy with cyclosporine (CYA), mycophenolate mofetil (MMF), or azathioprine (AZA) can maintain remission of the disease. The findings show that CYA leads to more rapid remission compared with MMF and AZA.
For the study, the researchers enrolled 96 individuals with systemic lupus erythematosus (SLE) and biopsy-proven LN. Of these, 56 were enrolled at diagnosis of LN, and 40 were enrolled during an LN flare.
For induction therapy, 92 patients (95.8%) received 3 methylprednisolone pulses followed by oral prednisone, and 4 patients (4.2%) received oral prednisone only. Among all the patients, 71 (74%) were treated with cyclophosphamide, 9 (9.4%) with MMF, 5 (5.2%) with AZA, and 11 (11.4%) with other immunosuppressors.
After 6 months, 30 patients (31.3%) began maintenance therapy with CYA, 32 (33.3%) with MMF, and 34 (35.4%) with AZA.
The mean follow-up after the beginning of the study was 15.9 years for the CYA group, 10.5 years for the MMF group, and 14.1 years for the AZA group. Renal response at 1, 5, and 10 years served as the primary endpoint.
At the start of maintenance therapy, the average serum creatinine level and estimated glomerular filtration rate were similar among the groups. Proteinuria was highest in the CYA group.
The complete response rates, partial response rates, and no response were 26.6%, 60.0%, and 13.4%, respectively, in the CYA group; 53.1%, 43.8%, and 3.1%, respectively, in the MMF group; and 38.2%, 58.8%, and 2.9%, respectively, in the AZA group.
At 1 year, after 6 months of maintenance therapy, the percentage of patients in the CYA group in complete remission increased to 73% compared with 65.6% in the MMF group and 40% in the AZA group. At 5 years, complete remission increased to 80% of patients in the CYA group compared with 83% in the MMF and AZA groups.
At 10 years, the percentage of patients in the CYA group in complete remission increased to 88% compared with 70% in the MMF group and 68% in the AZA group.
SLE flares were observed among 30% of patients in the CYA group, 41% in the MMF group, and 32% in the AZA group.
“Our study is the first to compare these three drugs as maintenance therapy in the long term,” lead study author Lorenza Maria Argolini, MD, a rheumatology consultant at Lupus Clinic, ASST Pini CTO, Milan, Italy, said in a press release. “Of interest are the results achieved in the CYA group where, despite worse clinical conditions at the beginning of maintenance therapy, we observed a rapid achievement of remission in the great majority of patients.”
—Melinda Stevens
References:
- Argolini LM, Elefante E, Saccon F, et al. Multicentric study comparing cyclosporine, mycophenolate mofetil and azathioprine in the maintenance therapy of lupus nephritis: 10 years follow up [EULAR OP0046]. Ann Rheum Dis. 2019;78(suppl 2):A93. http://scientific.sparx-ip.net/archiveeular/?view=1&c=a&searchfor=OP0046&item=2019OP0046. Accessed June 12, 2019.
- Cyclosporine benefits patients through more rapid remission of proteinuria in lupus nephritis [press release]. Madrid, Spain: Annual European Congress of Rheumatology; June 12, 2019. https://www.eular.org/sysModules/obxContent/files/www.eular.2015/1_42291DEB-50E5-49AE-5726D0FAAA83A7D4/04_abstract_op0046_cya_vs_aza_and_mmf_in_lupus_nephritis_final.pdf. Accessed June 12, 2019.