Background/Purpose: Lupus nephritis is a major cause of morbidity and mortality. The complete response rate is the most sensitive in detecting differences among therapeutic regimens. Mycophenolate mofetil has become the primary induction and maintenance therapy for lupus nephritis.

The purpose of this study was to assess the effect of MMF on the complete response after starting mycophenolate mofetil as initial therapy for class III, IV or V in immunosuppressant naïve patients with lupus nephritis by using 5 criteria including BMS, ACR, LUNAR, ALMS, and ACCESS.

Methods: This is a retrospective study on 21 SLE patients who had begun mycophenolate mofetil shortly after a biopsy-confirmed diagnosis of lupus nephritis. They consisted of 18 females, 3 males, 9 African Americans, 8 Caucasians, and 4 other ethnicities. Ages ranged from 18 to 70 with a mean age of 37 (SD=15). There were 5 patients with class III, 9 with class IV, 4 with class III-V, 1 with class IV-V and 2 with class V lupus nephritis. At baseline, 76% had positive anti-dsDNA, 67% had low C3, 57% had low C4 and 71% had albumin below 3.5. The initial dose of mycophenolate mofetil was 1000mg twice daily. If no improvement, it was increased to 1500 mg twice daily after one month. The baseline urine protein to creatinine ratio ranged between 0.635 to 11.91grams, with only 1 patient being below 1 gram at baseline. Patients were on a renal sparing regimen (52%) and hydroxychloroquine (86%). Depending on the response index, complete response was defined, as reaching a urine protein to creatinine ratio of < 0.2-0.5 grams, improvement in creatinine or estimated glomerular filtration rate of 10-25%, normalization of urinalysis and tapering dose of steroids.

Results: 52% of SLE patients reached 0.5 grams of proteinuria within 51 days of starting mycophenolate mofetil (95% confidence interval 29%-74%). 77% reached 0.5 grams or less within 260 days (95% confidence interval 57%-97%). The probability of response at 90 and 180 days is shown in the table for each response index.

Response Definition	Probability of   response within 90 days	Probability of response within 180 days
BMS	14%	38%
ACR	23%	58%
LUNAR/ALMS/ACCESS	24%	31%

Conclusion: This study demonstrates that the majority of previously naive immunosuppressant patients can reach a complete response within 6 months after initiation of mycophenolate mofetil. Furthermore, the estimate of long term response was highest in the ACR criteria.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/probability-of-3-and-6-month-complete-response-in-lupus-nephritis/