Attainment of Complete Renal Response in Patients with Active Lupus Nephritis: A Multi-Center Cohort Study

Arushi Ramnarain¹, Xiaomeng Xu², Joanna Kent³, Sagar Jagtiani⁴, Worawit Louthrenoo⁵, Laniyati Hamijoyo⁶, Shue-Fen Luo⁷, Yi-Hsing Chen⁸, Jiacai Cho⁹, Chiu Wai Shirley Chan¹⁰, Sandra Navarra¹¹, Haihong Yao¹², Lydia Pok¹³, BMDB Basnayake¹⁴, Zhuoli Zhang¹⁵, Madelynn Chan¹⁶, Sang-Cheol Bae¹⁷, Yasuhiro Katsumata¹⁸, Jun Kikuchi¹⁹, Sean O'Neill²⁰, Fiona Goldblatt²¹, Yih Jia Poh²², Mark Sapsford²³, Nicola Tugnet²⁴, Kristine Pek Ling Ng²⁵, Cherica Tee²⁶, Yoshiya Tanaka²⁷, Mandana Nikpour²⁸, Alberta Hoi²⁹, Eric Morand³⁰ and Rangi Kandane-Rathnayake³¹, ¹Monash Health, Melbourne, Victoria, Australia, ²GSK, Value, Evidence & Outcomes, Singapore, Singapore, ³Monash University, Department of Nephrology, Monash Health and Department of Medicine, Melbourne, Australia, ⁴Glaxo Smith Kline, Singapore, Singapore, ⁵Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand, Chiang Mai, Thailand, ⁶Hasan Sadikin Hospital, Jakarta Selatan, Indonesia, ⁷Chang Gung Memorial Hospital, Taipei, Taiwan, ⁸Taichung Veterans General Hospital, Taichung, TW, Taichung, Taiwan (Republic of China), ⁹National University Hospital, Singapore, Singapore, ¹⁰Division of Rheumatology and Clinial Immunology, Department of Medicine, the University of Hong Kong, Hong Kong, Hong Kong, China, ¹¹University of Santo Tomas, Manila, Philippines, ¹²People's Hospital, Peking University Health Science Center, Department of Rheumatology and Immunology, Beijing, China, ¹³University of Malaya Medical Center, Department of Medicine, Faculty of Medicine,, Kuala Lumpur, Malaysia, ¹⁴Teaching Hospital, Kandy, Sri Lanka, ¹⁵Peking University First Hospital, Beijing, China, ¹⁶Tan Tock Seng Hospital, Singapore, Singapore, ¹⁷Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea, ¹⁸Tokyo Women's Medical University School of Medicine, Tokyo, Japan, ¹⁹Keio University School of Medicine, Tokyo, Japan, ²⁰Liverpool Hospital; Royal North Shore Hospital; University of New South Wales and the University of Sydney, Sydney, New South Wales, Australia, ²¹Flinders Medical Centre, Adelaide, Australia, ²²SingHealth, Singapore, Singapore, ²³WDHB, Auckland, New Zealand, ²⁴Auckland District Health Board, Auckland, New Zealand, ²⁵Health New Zealand, Auckland, New Zealand, ²⁶Department of Pediatrics, College of Medicine, University of the Philippines, Manila, Philippines, ²⁷Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan, ²⁸The University of Sydney, Melbourne, Victoria, Australia, ²⁹Monash Health, Monash University, Melbourne, AU, Melbourne, Victoria, Australia, ³⁰School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia, ³¹Monash University, Clayton, Victoria, Australia

Meeting: ACR Convergence 2024

Keywords: autoimmune diseases, Cohort Study, Lupus nephritis, Systemic lupus erythematosus (SLE)

Session Information

Date: Monday, November 18, 2024

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

Session Type: Poster Session C

Session Time: 10:30AM-12:30PM

Background/Purpose: LN is prevalent in SLE, occurring in up to 50% of patients. Treatment response is evaluated by improvement in proteinuria and renal function, and achievement of remission is essential for better long-term outcomes. In clinical trials, only 30-40% of patients attain complete renal response (CRR) within 12 months of commencing immunosuppression. We assessed attainment of a modified definition of CRR (mCRR) in a large cohort of patients with SLE with active LN and compared patient characteristics between mCRR responders and non-responders.

Methods: Adult patients enrolled in a multinational observational cohort were studied prospectively from 2013 and 2020. Active LN was defined if patients had proteinuria defined by SLEDAI-2K criteria. The first visit with proteinuria during the observation period was defined as the index visit. Outcomes including mCRR (defined as urine protein creatinine ratio [uPCR] < 0.05 g/mmol and estimated glomerular filtration rate [eGFR] ≤10% below index value) and modified primary efficacy renal response (mPERR, defined as uPCR < 0.07 g/mmol and eGFR ≤20% below index value) were assessed annually over a 5-year period. Characteristics between mCRR responders and non-responders were compared using Wilcoxon rank-sum (numerical variables) and Chi-square (categorical variables) tests. The likelihood of mCRR attainment in subsequent years in patients who achieved mCRR at Year 2 was assessed using logistic regression analysis.

Results: In total, 1180 patients with active LN without exposure to biologics and with ≥2 visits (median [interquartile range, IQR] follow-up period: 2.7 years [1.0, 5.0]) were studied. Overall, 45.8% (482/1052) of patients attained mCRR at least once (mCRR responders) during the study period; the median (IQR) time to first mCRR attainment in mCRR responders was 6.2 (3.4, 12.9) months. mCRR was attained by 27.5% (186/956) at Year 1, 30.7% (145/665) at Year 2, and 22.6–26.6% at subsequent years. Of patients with ≥5 years of follow-up data (n=310), mCRR was attained by 19.5% (46/310) at Year 1, 27.6% (62/310) at Year 2, and 24.0–25.5% at subsequent years. (Table 1). Among those patients with ≥5 years follow up data, 40.8% (n=125/306) of this cohort attained mCRR responder status at least once. Compared with patients who never attained mCRR during 5-years of follow-up, mCRR responders were older, were less likely to be Asian, and almost all came from affluent countries with a gross domestic product exceeding Int. $50,000 (Table 2). mCRR responders at Year 2 had a significantly higher likelihood of mCRR attainment at subsequent years with odds ratios (95% confidence interval) at Years 3, 4, and 5 of 23.1 (12.4, 42.9), 13.8 (7.1, 26.5), and 19.6 (8.5, 45.3), respectively (Figure 1).

Conclusion: Almost half of this multinational study cohort with SLE and proteinuria attained mCRR after proteinuria was identified. mCRR attainment was highest at 2 years after proteinuria onset, and mCRR at Year 2 was associated with an increased likelihood of longer-term mCRR.

Table 1. Outcomes at annual visits following the index visit in patients with active LN.

Table 2. Patient characteristics, stratified by mCRR-ever attainment (at least once during study period).

Figure 1. mCRR attainment in subsequent years among patients who achieved mCRR at Year 2.

Disclosures: A. Ramnarain: None; X. Xu: GlaxoSmithKlein(GSK), 3; J. Kent: None; S. Jagtiani: GlaxoSmithKlein(GSK), 3; W. Louthrenoo: None; L. Hamijoyo: None; S. Luo: None; Y. Chen: None; J. Cho: None; C. Chan: None; S. Navarra: Astellas, 6, AstraZeneca, 6, Biogen, 2, Boehringer-Ingelheim, 2, GlaxoSmithKlein(GSK), 6, Novartis, 6, Pfizer, 6; H. Yao: None; L. Pok: None; B. Basnayake: None; Z. Zhang: None; M. Chan: None; S. Bae: None; Y. Katsumata: AstraZeneca, 6, GlaxoSmithKlein(GSK), 6; J. Kikuchi: None; S. O'Neill: None; F. Goldblatt: None; Y. Poh: None; M. Sapsford: None; N. Tugnet: None; K. Ng: None; C. Tee: None; Y. Tanaka: AbbVie, 6, Asahi-kasei, 6, Astellas, 6, AstraZeneca, 6, Boehringer Ingelheim, 5, 6, Chugai, 5, 6, Daiichi Sankyo, 6, Eisai, 6, Gilead, 6, GSK, 6, Lilly, 6, Pfizer, 6, Taisho, 5, 6, UCB, 6; M. Nikpour: AstraZeneca, 2, 5, 6, Boehringer-Ingelheim, 2, 5, 6, Bristol-Myers Squibb(BMS), 5, GlaxoSmithKlein(GSK), 6, Janssen, 2, 5, 6; A. Hoi: AbbVie/Abbott, 6, AstraZeneca, 5, Australian Rheumatology- Association, 4, 12, Treasurer, Eli Lilly, 6, EUSA Pharma, 2, Limbic, 6, Moose Republic, 6, Novartis, 6; E. Morand: AbbVie, 5, Amgen, 5, AstraZeneca, 1, 2, 5, 6, Biogen, 2, 5, Bristol Myers Squibb, 2, 5, Dragonfly, 2, Eli Lilly, 5, EMD Serono, 2, 5, Genentech, 2, 5, Gilead, 2, GSK, 2, 5, Janssen, 5, Novartis, 2, 5, RemeGen, 2, Roche, 5, 6, Takeda, 2, 5, UCB, 5, Zenas, 2; R. Kandane-Rathnayake: GlaxoSmithKline(GSK), 5, Janssen, 5, Novartis, 5.

To cite this abstract in AMA style:

Ramnarain A, Xu X, Kent J, Jagtiani S, Louthrenoo W, Hamijoyo L, Luo S, Chen Y, Cho J, Chan C, Navarra S, Yao H, Pok L, Basnayake B, Zhang Z, Chan M, Bae S, Katsumata Y, Kikuchi J, O'Neill S, Goldblatt F, Poh Y, Sapsford M, Tugnet N, Ng K, Tee C, Tanaka Y, Nikpour M, Hoi A, Morand E, Kandane-Rathnayake R. Attainment of Complete Renal Response in Patients with Active Lupus Nephritis: A Multi-Center Cohort Study [abstract]. Arthritis Rheumatol. 2024; 76 (suppl 9). https://acrabstracts.org/abstract/attainment-of-complete-renal-response-in-patients-with-active-lupus-nephritis-a-multi-center-cohort-study/. Accessed .

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