Mycophenolic acid maintenance reduces flare rate in lupus nephritis
Effective induction of immunosuppression and mycophenolic acid (MPA) as maintenance treatment has resulted in a relatively low flare rate for lupus nephritis in recent years, according to a study.
The investigators analysed data on 139 Chinese patients with class III/IV±V lupus nephritis diagnosed from January 1983 to December 2013. They also compared data before and after 1998 when maintenance immunosuppression was changed from azathioprine (AZA) to MPA.
A total of 135 episodes of renal flare occurred during 112.5±88.4 months, yielding a flare rate of 0.108 episodes per patient-year. Calculated from the start of induction treatment, the rate of renal relapse-free survival was 96 percent at 1 year, 90 percent at 2 years, 86 percent at 3 years, 80 percent at 4 years, 69 percent at 5 years and 57 percent at 10 years.
Lower flare risk correlated with MPA maintenance (odds ratio [OR], 0.314; 95 percent CI, 0.099 to 0.994; p=0.049), complete remission after induction immunosuppression (OR, 0.329; 0.133 to 0.810; p=0.016) and diagnosis after 1998 (OR, 0.305; 0.133 to 0.700; p=0.005).
Patients treated with prednisolone and MPA as maintenance immunosuppression had significantly better relapse-free survival (91 percent after 5 years and 83 percent after 10 years, respectively) compared with those who received prednisolone and AZA (70 and 52 percent, respectively; p=0.044).
Lupus nephritis diagnosed between 1998 and 2013 showed 5- and 10-year relapse-free survival rates of 93 and 86 percent, respectively, compared with 81 and 66 percent, respectively (p=0.017) for lupus nephritis that presented between 1983 and 1997.