OUTCOMES OF MAINTAINENCE THERAPY IN LUPUS NEPHRITIS

Abstract

Background: Lupus nephritis is a potentially fatal complication of SLE, which needs an extended period of maintenance therapy after successful induction therapy. The purpose of our study was to compare the outcome of lupus nephritis with various maintenance therapies.

Objectives:  To study the outcome of maintenance therapy in lupus nephritis using different treatment regimes ( cyclophosphamide Vs MMF Vs Tacrolimus )

Participants: 50 diagnosed cases of SLE with lupus nephritis stage III , IV , V , III+V, and IV+V

Study Design:  Hospital-based observational study
Methods: Lupus nephritis patients who had successfully completed induction regimes with either cyclophosphamide (CYC) or Mycophenolate Mofetil (MMF) were followed quarterly with the disease over a period of 2 years. The primary endpoint of complete response and secondary endpoint of partial response was compared in different treatment arms and subjected to the statistical analysis.
Results: A total of 50 patients were studied with a mean age of 26.5±6.75 years, with the majority (97%) of them being females (n=47). The majority (54%) of patients belonged to Lupus nephritis class IV (n=27). Out of 50 patients, MMF was received by half of the patients (n=25), 24% received Azathioprine (AZA) (n=12), 14% received cyclophosphamide (n=7), 10% received Tacrolimus (n=5) and only one patient received Rituximab. More than 50% (n=26) patients achieved the primary endpoint of complete response and over 28% (n=15) achieved secondary end point of partial response.

Conclusion: Patients on Azathioprine had a better outcome and less failure rates, however, the difference in outcome between MMF (CR 40%, PR 36% and relapse rate of 16%) and Azathioprine (CR 75%, PR 25%, and relapse rate of 0%), between MMF and CYC (CR 42.9%, PR 28.6% and relapse rate of 14.3%) and between Azathioprine and cyclophosphamide didn’t reach statistical significance (P values MMF vs AZA =0.163, MMF vs CYC =0.952 and AZA vs CYC =0.243).
Implications: Azathioprine and cyclophosphamide are effective alternatives to MMF as maintenance therapy in lupus nephritis.