Background/Purpose: A paucity of data exists that delineates the effect of current medications for lupus on disease activity and the propensity for renal flares in these patients.

Methods: Data from a registry of SLE patients collected from 16 medical centers in the US and Canada in which patients are seen regularly to evaluate the association between specific medications and the incidence of renal flares over an average of 1.8 years of observation. The percentage of patients with low levels of disease activity (SLEDAI ≤ 4 ) at entry who maintained these same levels of low disease activity was calculated, as was the percentage of patients who entered at higher levels of disease activity (SELENA SLEDAI >4) but became inactive at 6 months and remained at that low level of disease activity during follow-up.

Results: Of the 1299 patients with any follow-up, 103 subjects were taking Azathioprine plus Hydroxychloroquine (AZA+HCQ), 312 were on Mycophenolate Mofetil  (MMF) plus HCQ, 111 were on MMF alone, 502 were on HCQ without other immunosuppressant drugs and 271 were on none of these medications.  Six-hundred and eleven had a history of renal disease at study entry; mean Prednisone dose did not significantly differ between the five medication groups and the SLEDAI score was significantly lower in the HCQ alone group.  The incidence of renal flares ranged from 14%-37% with the lowest incidence in the HCQ group, but no statistically significant differences were noted.  The incidence of severe renal flares varied from 7%-13% with the lowest in the MMF alone group and the highest in the MMF+HCQ group, though any differences were not statistically significant.  Among subjects with a history of nephritis, the incidence of severe renal flares did not differ between those who were using Prednisone at enrollment compared with those who were not. Logistic regression was used to identify significant, independent risk factors for renal flares; only older age and higher baseline SLEDAI scores were associated with severe renal flares, while race/ethnicity, disease duration, gender and medications were not.  Among patients who entered with low levels of disease activity (SLEDAI ≤ 4) and maintained these low levels of activity, the group using HCQ alone was significantly more likely to maintain low levels of disease activity (46% for HCQ group compared to 20%-27% for the other groups). 

Conclusion: The results of this study suggest that over a period of almost two years, approximately one-third of SLE patients, even those with nephritis; can be maintained at a low level of disease activity with current maintenance therapies.  Over that period, approximately 1/3 of patients have renal flares and approximately 10% have severe renal flares.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/effects-of-current-therapies-for-lupus-on-disease-activity-and-renal-flares/