ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 2082

A Prospective Study on Long-Term Clinical Outcomes of Patients with Lupus Nephritis Treated with an Intensified B-Cell Depletion Protocol Without Maintenance Therapy

Dario Roccatello1, Savino Sciascia2, Carla Naretto1, Mirella Alpa1, Roberta Fenoglio1, Michela Ferro1, Giacomo Quattrocchio1, Elena Rubini1, Elnaz Rahbani1, Vittorio Modena1 and Daniela Rossi1, 1University of Turin, Turin, Italy, 2University of Turin, Torino, Italy

Meeting: ACR Convergence 2022

Keywords: , ,

Session Information

Date: Monday, November 14, 2022

Title: SLE – Diagnosis, Manifestations, and Outcomes Poster III: Outcomes

Session Type: Poster Session D

Session Time: 1:00PM-3:00PM

Background/Purpose: We aimed to investigate the safety and efficacy of an intensified B-cell depletion induction therapy (IBCDT) without immunosuppressive maintenance regimen compared with standard of care in biopsy-proven Lupus Nephritis (LN).

Methods: Thirty patients were administered an IBCDT (4 weekly rituximab [RTX] 375 mg/m2 and 2 more doses after 1 and 2 months; 2 infusions of 10 mg/kg cyclophosphamide [CYC], 3 methylprednisolone pulses), followed by oral prednisone (tapered to 5 mg/d by the third month). No immunosuppressive maintenance therapy was given. Thirty patients matched for LN class and age were selected as controls: 20 received 3 methylprednisolone pulses days followed by oral prednisone and mycophenolate mofetil (MMF) 2 to 3 g/d, whereas 10 were given the Euro Lupus CYC. MMF (1-2 g/daily) or azathioprine (AZA, 1-2 mg/kg/day) were given for > 3 years as a maintenance therapy.

Results: At 12 months, complete renal remission was observed in 93% of patients on IBCDT, in 62.7% on MMF, and in 75% on CYC (P = 0.03); the dose of oral prednisone was lower in the IBCDT group (mean ± SD 2.9 ± 5.0 mg/dl) than MMF (10.5 ± 8.0 mg/d, P < 0.01) or CYC group (7.5 ± 9.0 mg/d, P < 0.01). Mean follow-up after treatment was 44.5 months (interquartile range [IQR] 36-120 months), 48.6 months (IQR 36-120 months), and 45.3 (IQR 36-120 months) for IBCDT, MMF, and CYC, respectively. At their last follow-up visit, we observed no significant differences in proteinuria and serum creatinine, nor in the frequency of new flares among the 3 groups.

Conclusion: In biopsy-proven LN, the IBCDT without further immunosuppressive maintenance therapy was shown to be as effective as conventional regimen of MMF or CYC followed by >3-year maintenance either MMF or AZA regimen. Moreover, the use of IBCDT was associated with a marked reduction of glucocorticoid cumulative dose.

Disclosures: D. Roccatello, None; S. Sciascia, None; C. Naretto, None; M. Alpa, None; R. Fenoglio, None; M. Ferro, None; G. Quattrocchio, None; E. Rubini, None; E. Rahbani, None; V. Modena, None; D. Rossi, None.

To cite this abstract in AMA style:

Roccatello D, Sciascia S, Naretto C, Alpa M, Fenoglio R, Ferro M, Quattrocchio G, Rubini E, Rahbani E, Modena V, Rossi D. A Prospective Study on Long-Term Clinical Outcomes of Patients with Lupus Nephritis Treated with an Intensified B-Cell Depletion Protocol Without Maintenance Therapy [abstract]. Arthritis Rheumatol. 2022; 74 (suppl 9). https://acrabstracts.org/abstract/a-prospective-study-on-long-term-clinical-outcomes-of-patients-with-lupus-nephritis-treated-with-an-intensified-b-cell-depletion-protocol-without-maintenance-therapy/. Accessed .

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-prospective-study-on-long-term-clinical-outcomes-of-patients-with-lupus-nephritis-treated-with-an-intensified-b-cell-depletion-protocol-without-maintenance-therapy/