Session Information
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: Low-dose intravenous cyclophosphamide (Euro-lupus) and Mycophenolate mofetil (MMF) are well established in lupus nephritis induction therapy, but there are few studies comparing both treatments. Our aim was to compare their efficacy and safety after 6-month induction therapy
Methods: Retrospective analysis of a prospective cohort of a single tertiary center. Patients with active lupus nephritis were treated with Euro-lupus (500mg, 15/15 days for 3 months, followed by MMF / azathioprine) or MMF (3g/day) as induction therapy. Clinical and laboratory data were evaluated at baseline and after 6 months. Serious infectious were defined as infections requiring hospitalization and/or intravenous antibiotics. Exclusion: creatinine clearance <10mL/min and pregnancy.
Results: 40 patients received Euro-lupus and 70 patients received MMF. Euro-lupus and MMF groups were comparable in age (35.23 ± 10.32 vs. 37.43 ± 11.43 years, p=0.316), female gender (85.0 vs. 84.2%, p=1.0), white race (75.0 vs. 62.9%, p=0.212) and disease duration (5.65 ± 5.64 vs. 6.20 ± 6.44 years, p=0.653). Baseline laboratory parameters, SLEDAI and glucocorticoid therapy data are shown in table 1. The frequency of previous nephritis (70.0 ± 60.0%, p = 0.312), systolic blood pressure (BP) levels (p=0.597) and diastolic BP (p=0.217) were comparable in the two groups. Six-month laboratory parameters, SLEDAI and glucocorticoid therapy data are shown in table 2. After 6 months, Euro-lupus had a higher increase in C3 (p=0.038) and C4 (p=0.046) levels and a greater reduction in prednisone daily dose (-24.69 ± 14.72 vs. -18.43 ± 13.97 mg/day, p=0.029) than MMF. Euro-lupus presented higher frequency of serious infections (22.5 vs. 7.1%, p=0.034) than MMF.
Conclusion: Euro-lupus and MMF protocols were effective as induction therapy for active lupus nephritis with a comparable frequency of patients achieving the proteinuria target and in spite of worse baseline parameters in the former group. The higher frequency of serious infection in Euro-lupus group may be associated with more aggressive glucocorticoid regimen in these patients.
Table 1: Baseline laboratory parameters, SLEDAI and glucocorticoid therapy data of Euro-lupus vs. MMF
|
Euro-lupus |
MMF |
p |
|
|
Creatinine, mg/dL |
1.08 ± 0.82 |
0.85 ± 0.32 |
0,039* |
|
Albumin, g/dL |
3.20 ± 0.56 |
3.35 ± 0.59 |
0.243 |
|
Positive anti-dsDNA |
31 (77.5%) |
46 (65.7%) |
0.279 |
|
C3, mg/dL |
64.93 ± 29.59 |
72.27 ± 29.42 |
0.212 |
|
C4, mg/dL |
10.10 ± 8.17 |
12.05 ± 9.17 |
0.267 |
|
24-hour proteinuria, g |
2.46 ± 1.84 |
2.21 ± 1.39 |
0.434 |
|
Presence of hematuria |
35 (87.5%) |
43 (61.4%) |
0.004* |
|
SLEDAI |
13.80 ± 5.64 |
11.69 ± 5.87 |
0.068 |
|
Prednisone dose, mg/day |
44.00 ± 15.20 |
37.71 ± 16.37 |
0.049* |
|
IV methylprednisolone |
32 (80.0%) |
42 (60.0%) |
0.036* |
Table 2: 6-month laboratory parameters, SLEDAI and glucocorticoid therapy data of Euro-lupus vs. MMF
|
Euro-lupus |
MMF |
p |
|
|
Creatinine, mg/dL |
0.89 ± 0.47 |
0.82 ± 0.34 |
0.342 |
|
Albumin, g/dL |
3.88 ± 0.46 |
3.61 ± 0.74 |
0.070 |
|
Positive anti-dsDNA |
18 (45.0%) |
24 (34.3%) |
0.310 |
|
C3, mg/dL |
97.03 ± 26.03 |
91.32 ± 28.06 |
0.300 |
|
C4, mg/dL |
19.42 ± 10.77 |
16.87 ± 9.09 |
0.190 |
|
24-hour proteinuria, g |
0.64 ± 0.48 |
0.89 ± 1.19 |
0.216 |
|
24-hour proteinuria <0.8g/day |
29 (72.5%) |
47 (67,1%) |
0.669 |
|
Presence of hematuria |
13 (32.5%) |
18 (25.7%) |
0.511 |
|
SLEDAI |
4.75 ± 3.44 |
4.51 ± 4.06 |
0.751 |
|
Prednisone dose, mg/day |
19.31 ± 10.99 |
19.28 ± 13.08 |
0.991 |
To cite this abstract in AMA style:
Munhoz G, Lacerda M, Lopes M, Borba EF, Seguro L, Bonfa E. Induction of Lupus Nephritisin in Real Situation: Cyclophosphamide or Mycophenolate Mofetil? [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/induction-of-lupus-nephritisin-in-real-situation-cyclophosphamide-or-mycophenolate-mofetil/. Accessed .« Back to 2017 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/induction-of-lupus-nephritisin-in-real-situation-cyclophosphamide-or-mycophenolate-mofetil/