Session Information
Date: Tuesday, November 15, 2016
Title: Systemic Lupus Erythematosus – Clinical Aspects and Treatment - Poster III: Biomarkers and Nephritis
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: Sustained complete remission is an independent predictor of good long term prognosis in lupus nephritis (LN). We aimed to examine the predictors of sustained complete renal remission (CR) in patients with LN.
Methods: We reviewed patients with active LN at a single center Lupus Clinic where patients were followed prospectively according to a standardized protocol between 1970 and December 2015. We identified the patients who had a minimum of 5 years of follow-up after the diagnosis of LN. We compared demographic, disease activity, renal histology (according to the World Health Organization/ International Society of Nephrology classification), laboratory and treatment variables at the time of diagnosis of LN in patients who never achieved complete renal remission (group A), those who achieved sustained CR for less than 5 years (group B), and those who had at least 5 years of CR (group C). Proportional logistic regression models were constructed to identify the predictors of sustained CR among the 3 groups in multivariate models controlling for gender, age, disease duration, ethnicity, comorbidity and treatment. Subgroup analyses were also undertaken in patients with biopsy-proven LN.
Results: A total of 427 patients were identified, 82 (19%) in group A, 213 (50%) in group B and 132 (31%) in group C. At the diagnosis of LN, gender, age, SLE duration, ethnic origin, renal biopsy results and treatment were comparable in the three groups. The patients in group C had lower renal SLE disease activity index-2K (renal SLEDAI-2K) and lower frequency of hypocomplementemia (table 1). Multivariate analysis in the whole cohort revealed higher renal SLEDAI-2K had a lower probability of sustained CR (table 2). Subgroup analysis revealed older age had a higher probability of sustained CR (odd ratio (OR) = 1.03; 95% confident interval (CI), 1.00-1.05; P = 0.03) in addition to renal SLEDAI-2K. There was no association between renal histology class III or IV and the probability of sustained CR.
Conclusion: At the time of diagnosis of LN, higher renal SLEDAI-2K predicts less chance of sustained CR.
| Table 1 Comparison of clinical variables at the time of LN diagnosis | |||
|
Variables |
Group A (N=82) |
Group B (N=213) |
Group C (N=132) |
| Female, n (%) |
68 (82.9) |
182 (85.4) |
113 (85.6) |
| Age (mean± SD, year) |
26.71 ± 11.44 |
27.03 ± 11.61 |
29.09 ± 13.32 |
| SLE duration (mean± SD, year) |
5.90 ± 6.25 |
4.72 ± 5.69 |
4.85 ± 5.50 |
| WHO/ISN Renal histology: class III, IV, or IV/V, n/N (%) |
20/36(55.6) |
79/146(54.1) |
49/93(52.7) |
| Baseline serum creatinine (mean± SD, umol/l ) |
112.65 ± 133.70 |
92.55 ± 68.69 |
97.00 ± 97.56 |
| Renal- SLEDAI-2K (mean± SD) |
7.66 ± 4.23 |
5.35 ± 4.79 |
4.06 ± 4.50 |
| Non renal- SLEDAI-2K (mean± SD) |
6.13 ± 5.60 |
5.99 ± 5.92 |
5.92 ± 5.19 |
| Low complement, n (%) |
56 (68.3) |
110 (52) |
70 (53) |
| Abnormal double stranded DNA, n (%) |
58 (70.7) |
119 (55.9) |
72 (54.5) |
| Treatment with steroids, n (%) |
64 (78) |
173 (81) |
107 (81) |
| Treatment with anti-malarial agent, n (%) |
38 (46.3) |
86 (40.4) |
53 (40.2) |
| Treatment with immunosuppressive agents, n (%) |
41 (50) |
77 (36.2) |
48 (36.4) |
SD = standard deviation
| Table 2 Multivariate Proportional Logistic regression Analysis – cohort size = 427 | ||
|
Predictors at the time of diagnosis of LN |
OR (95% CI) |
P |
| Age | 1.01 (0.99-1.03) | 0.19 |
| Duration of LN | 0.97 (0.97-1.01) | 0.11 |
| Caucasian | 1.46 (0.99-2.14) | 0.05 |
| Renal SLEDAI-2K | 0.89 (0.85-0.93) | <0.001 |
| Cumulative steroid dose within 3 years prior LN (g) | 1.02 (0.99-1.04) | 0.10 |
| Treatment with anti-malarial agent | 0.78 (0.53-1.15) | 0.22 |
To cite this abstract in AMA style:
Pakchotanon R, Gladman DD, Su J, Urowitz M. The Predictors of Sustained Complete Remission in Lupus Nephritis [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/the-predictors-of-sustained-complete-remission-in-lupus-nephritis/. Accessed .« Back to 2016 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-predictors-of-sustained-complete-remission-in-lupus-nephritis/