Background/Purpose: Lupus nephritis (LN) is more common in children (occurs in 50-82%) compared to adults. Cyclophosphamide (CYC) and mycophenolate mofetil (MMF) are both treatment options for childhood-onset SLE with LN. Both options are included in the recommendations for the management of LN. However, in children, the optimal treatment of LN is still unknown.

Methods: Single center retrospective cohort study included patients ≤18 years old with SLE with nephritis diagnosed between 2008 and 2024.

Results: A total of 231 patients were included in the study. The proportion of participants who were shifted to another treatment due to poor response was significantly higher among those in the MMF group (81.82% vs. 50.00%, p=0.001), while the proportion of those who were shifted due to preference was higher in CYC group. The overall incidence rate of complete renal response was 4.86 per 100 person-months, 4.91 per person-months in the CYC group and 4.71 per person-months in the MMF group. 77.01% of the CYC group had complete renal response, while the MMF group had a rate of 84.21%. During the first-year post-treatment, the median number of flares was significantly higher in the MMF group compared to CYC. Females were 6.85-times more likely to be shifted to another treatment, while those who received MPPT were 2.86-times less likely to be shifted to another treatment. The odds of being shifted to another treatment decreases by 25% for every 1-milligram increase in the daily dosage of prednisone. Females and having tuberculosis increased the odds of shifting to another treatment by 6.14-times and 4.87-times, respectively. In the CYC group who received RTX were 6.67-times less likely to be shifted to another treatment. The likelihood of shifting from MMF to another treatment decreased by 19.00% for every 1-milligram increase in the daily prednisone dosage.

Conclusion: Both CYC and MMF are effective treatments for cSLE with LN, with CYC showing a faster response time compared to MMF (13 months vs 24 months). The probability of complete renal response at 6 months for those in the CYC group was approximately 80%, while those in the MMF group was about 70%. However, patients who were shifted between treatments had a significantly better renal outcome. Early adjustments in therapy may improve long-term results. A personalized approach considering the patient’s clinical characteristics, risk factors, and response to therapy is crucial in managing cSLE with LN.

Between-Group Comparisons of the Renal Response Rates and Outcomes Between the Two Groups among Childhood Systemic Lupus Erythematosus (cSLE) with Lupus Nephritis in the University of Santo Tomas Hospital from January 2008 to September 2024 (N = 231)

Comparative Analyses of the Reasons for Shifting to Another Treatment among Childhood Systemic Lupus Erythematosus (cSLE) with Lupus Nephritis in the University of Santo Tomas Hospital from January 2008 to September 2024 (N = 231)

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/effectiveness-of-iv-cyclophosphamide-and-mycophenolate-mofetil-in-the-treatment-of-pediatric-systemic-lupus-erythematosus-with-lupus-nephritis/