Eurolupus and Low Steroid Regimen in Proliferative Lupus Nephritis: Retrospective Evaluation of 38 Patients in the Black Population of Martinique

Charles Cartou¹, Katlyne Polomat², Florence MOINET², Serge ARFI³, Lauren Brunier-Agot⁴, Marie Blattery⁵, Aymeric Couturier⁶, Georges JEAN BAPTISTE⁷, Michel De Bandt⁸ and Christophe Deligny⁹, ¹nephrology, Pierre Zobda Quitman Hospital, Fort de France, Martinique, ²Rheumatology and Internal Medicine, Zobda Quitman Hospital, Fort de France, Martinique, ³University Hospital, CHU Fort de France, Fort de France, Martinique, ⁴Internal medicine and rheumatology, Zobda Quitman Hospital, Fort de France, Martinique, ⁵rheumatology, Pierre Zobda Quitman hospital, Fort de France, Martinique, ⁶nephrology, Pierre Zobda Quitman hospital, Fort de France, Martinique, ⁷RHEUMATOLOGY, CHU MARTINIQUE, FWI, Fort-de-France, Martinique, ⁸CHU Fort de France, Fort de France, France, ⁹Zobda Quitman Hospital, Rheumatology and Internal Medicine, Fort de France, Martinique

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: cyclophosphamide, Ethnic studies, lupus nephritis and systemic lupus erythematosus (SLE)

Session Information

Date: Sunday, November 13, 2016

Title: Systemic Lupus Erythematosus – Clinical Aspects and Treatment - Poster I: Clinical Trial Design and Current Therapies

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: There is no data on the efficacy of the EUROLUPUS regimen associated with initial low steroids daily dose in African descent patients with proliferative lupus nephritis (LN). Here we report the 3 years prognosis of LN in black Martinican patients treated with low dose of cyclophosphamide and low dose steroids.

Methods: All patients suffering from LN in our unit have the choice after information to receive mycophénolate or IV cyclophosphamide (CY) as attack treatment. In the absence of rapidly progressive glomerulonephritis and severe extra-renal manifestations (mainly CNS involvement, auto-immune anemia or thrombocytopenia), the patients received no prednisolone assault, 6 IV 500mg fortnightly CY pulses and an initial 0.5 mg/kg/d daily dose of prednisone. On 117 consecutive SLE Afro-Caribbean patients biopsied with LN (ISN-RPS class III, IV) from 11/2008 until 9/2015, 38 living in Martinique were treated in our unit and retrospectively evaluated for complete remission (CR, daily proteinuria < 0.5 g, no urine sediment, no > 10% increasing creatininemia), partial remission (PR, same criteria than CR except for daily proteinuria < 1g), treatment failure (persistance of nephrotic proteinuria or creatininemia < 114 microM if initially < 228 microM or no decrease under half the initial creatininemia level if > 228 microM), dialysis, All patients were followed the same way. Maintenance treatment was azathioprine (n=8), mycophenolate (n=30). No patient was excluded on a creatininemia level or incompliance basis (based on self declaration).

Results: Mean (+/-SD) age at LN diagnosis was 30 (+/-9.5) years. 44.7% of patients had LN recurrence. The renal biopsy classes were: III+/-V (39.5%), IV+/-V (60.5%). Mean (+/-SD) follow up time was 49.8 (+/-27.3) months. Mean (+/-SD) baseline parameters were: glomerular filtration rate 74.75 (+/-44.17) ml/min/1.73 m², proteinuria 2.92 (+/-2.17) g/d, high blood pressure (57.9%), mean initial prednisone daily dose 32.2 (+/-13.2) mg/d. Five patients (13.1%) received initially at least one 1g prednisolone assault. Total remission (CR+PR) rates were 21.1% at 3 months (CR15.8%, PR 5.2%), 52.6% at 6 months (CR 34.2%, PR 18.4%), 68.4% at 1 year (CR 50%, PR 18.4%), 78.9% at 2 year (CR 65.8%, PR 13.2%), 81.6% at 3 year (CR 71.1%, PR 10.5%). No patient died and none were lost to follow up. Treatment failure was 15.8% at 3 years, 5/6 (83.3%) being non compliant. At 3 years, 5 patients were on dialysis.

Conclusion: Despite inclusion of non compliant patients, our results suggests that EUROLUPUS with low steroid use can be an effective regimen in African descent patients with proliferative LN.

Disclosure: C. Cartou, None; K. Polomat, None; F. MOINET, None; S. ARFI, None; L. Brunier-Agot, None; M. Blattery, None; A. Couturier, None; G. JEAN BAPTISTE, None; M. De Bandt, None; C. Deligny, None.

To cite this abstract in AMA style:

Cartou C, Polomat K, MOINET F, ARFI S, Brunier-Agot L, Blattery M, Couturier A, JEAN BAPTISTE G, De Bandt M, Deligny C. Eurolupus and Low Steroid Regimen in Proliferative Lupus Nephritis: Retrospective Evaluation of 38 Patients in the Black Population of Martinique [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/eurolupus-and-low-steroid-regimen-in-proliferative-lupus-nephritis-retrospective-evaluation-of-38-patients-in-the-black-population-of-martinique/. Accessed .

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