Long-Term Outcome of Tacrolimus Therapy As a Maintenance Strategy in Patients with Lupus Nephritis

Yun Jung Choi¹, Won-Seok Lee², Myong-Joo Hong³, Chang-Hoon Lee⁴, Myeung Su Lee⁵, Young Sun Suh⁶, Sang-Il Lee⁷ and Wan-Hee Yoo⁸, ¹Division of Rheumatology, Department of Internal Medicine, Chonbuk National University Medical School and Research Institute of Clinical Medicine of Chonbuk National University Hospital-Chonbuk National University, JeonJu, South Korea, ²Division of Rheumatology, Department of Internal Medicine, Chonbuk National University Medical School and Research Institute of Clinical Medicine of Chonbuk National University Hospital-Chonbuk National University, jeonju, South Korea, ³Internal Medicine, Presbyterian Medical center, Jeonju, South Korea, ⁴Department of Internal Medicine, School of Medicine, Wonkwang University, Iksan, Chonbuk, South Korea, ⁵Internal Medicine, School of Medicine, Wonkwang University, Iksan, Chonbuk, South Korea, ⁶Division of Rheumatology, Department of Internal Medicine, School of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, South Korea, ⁷Division of Rheumatology, Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, South Korea, ⁸Division of Rhuematology, Department of Internal Medicine, Chonbuk National University Medical School and Research Institute of Clinical Medicine of Chonbuk National University Hospital-Chonbuk National University, Jeonju, South Korea

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: Tacrolimus

Session Information

Date: Monday, November 9, 2015

Title: Systemic Lupus Erythematosus - Clinical Aspects and Treatment Poster Session II

Session Type: ACR Poster Session B

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

Background/Purpose: Lupus nephritis(LN) is one of the significant cause of mortality in patients with systemic lupus erythematosus. Tacrolimus, a calcineurin inhibitor widely used in prevention of organ transplant rejections, has been recently applied to the treatment of LN due to its immunosuppressive effects. However, there are few reports regarding the long-term effects of tacrolimus as a maintenance treatment of LN. We aimed to investigate long-term outcomes and tolerability of tacrolimus after being switched from azathioprine or mycophenolate mofetil (MMF) due to intolerability.

Methods: The records of 27 LN patients who received tacrolimus treatment for 39.2month(S.D 1.2) were reviewed retrospectively. Tacrolimus was used as a maintenance therapy alternative to azathioprine (n = 13) or MMF (n = 16) after treatment with high-dose glucocorticoids and cyclophosphamide or MMF in all patients.

Results: After induction therapy with high-dose glucocorticoids and cyclophosphamide or MMF, proteinuria (3.4 ± 3.34 to 1.56 ± 1.78 g/24 hr), GFR (81.83 ± 28.1 to 119.34 ± 32.64 mL/min/1.73m²), serum C3 (51.64 ± 20.21 to 73.34 ± 19.0mg/dL), C4 (8.54 ± 6.04 to 13.8 ± 6.98 mg/dL) and anti-dsDNA antibody (92.45 ± 74.54 to 72.78 ± 68.67 IU/mL) improved. These improvements were maintained by tacrolimus therapy 39 months after changing from MMF or azathioprine(proteinuria, 0.22 ± 0.19g/24 hr; GFR, 110.06 ± 36.84 mL/min/1.73m²; serum C3, 77.27± 15.85 mg/dL; C4, 14.88 ± 6.33mg/dL; and anti-dsDNA antibody, 48.87 ± 55.01 IU/mL). One patient developed end-stage renal failure, and the1-, 2- and 3-year renal survival rates were 100%, 96%, and 96%, respectively. Two patients (7.4%) had infections that required hospitalization (urinary tract infection or herpes zoster) and four patients had hair loss. One death occurred because of biliary cancer.

Conclusion: In our study, the efficacy and tolerability of tacrolimus in treating LN as a maintenance therapy was favorable with minor complications. Further detailed investigations to confirm its long term efficacy and safety will be needed for identifying its role as a long-term maintenance agent.

Disclosure: Y. J. Choi, None; W. S. Lee, None; M. J. Hong, None; C. H. Lee, None; M. S. Lee, None; Y. S. Suh, None; S. I. Lee, None; W. H. Yoo, None.

To cite this abstract in AMA style:

Choi YJ, Lee WS, Hong MJ, Lee CH, Lee MS, Suh YS, Lee SI, Yoo WH. Long-Term Outcome of Tacrolimus Therapy As a Maintenance Strategy in Patients with Lupus Nephritis [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/long-term-outcome-of-tacrolimus-therapy-as-a-maintenance-strategy-in-patients-with-lupus-nephritis/. Accessed .

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