Background/Purpose:

Lupus nephritis is one of the most common and severe manifestations of patients with SLE. Studies assessing the use of Tacrolimus (TAC) in lupus nephritis are promising, however results are primarily based on patients of Asian ethnicity and limited by significant heterogeneity. The Los Angeles County + University of Southern California Medical Center (LAC+USC) serves a largely Hispanic, underinsured, indigent population. The purpose of this study is to evaluate the use and effectiveness of TAC in LAC+USC Rheumatology clinic.

Methods:

This is a retrospective analysis of adult patients with SLE, satisfying the 1997 ACR criteria, from LAC+USC medical center seen from January 2010 to January 2018. Patients with biopsy proven lupus GN were identified and screened for previous or current use of TAC. Patient demographics, 2003 International Society of Nephrology (ISN)/Renal Pathology Society (RPS) Classification of lupus nephritis, treatment history, laboratory features, and SLEDAI were noted. Renal response as defined by the 2006 ACR response criteria for proliferative and membranous renal disease was calculated for each patient.

Results:

Ten patients were included (100% female, mean age 32.3±8.8 years, mean disease duration 8.2±5.2 years). Ninety percent were Hispanic and 10% were African American. Hypertension was present in 70% of patients and diabetes mellitus in 10%. Eighty percent of patients were on an angiotensin converting enzyme inhibitor/angiotensin II receptor blocker. According to ISN/RPS class, patients were Class V (50%), III/V (40%), IV/V (10%). The most common indication of TAC was refractory or resistant lupus nephritis therapy as determined by physician judgment, persistent proteinuria, persistent active sediment, hypocomplementemia or elevated dsDNA. Median daily dose of TAC was 4mg. Mean duration of therapy 1.2±0.8 years. Previous medications included GC (70%; mean daily dose 7.5mg), CYC (70%), MMF (100%), AZA (60%), RTX (80%), CSA (10%), Belimumab (30%), HCQ (70%). According to ACR response criteria, 60% of patients had no change, 10% worsened, 10% had partial response, 20% achieved complete response, 0% improved. Median urine protein creatinine ratio increased from 2.0 at baseline to 2.3 (p=0.99). Median SLEDAI decreased from 16.5 at baseline to 16.0 (p=0.97). Median creatinine did not change from baseline 0.7mg/dL (p=0.16). TAC was discontinued in 8 patients due to inefficacy.

Conclusion:

The study demonstrates the use of TAC in a primarily Hispanic population with refractory lupus nephritis. Although small and uncontrolled, the data proposes that TAC may not be as effective in Hispanics with refractory lupus nephritis in achieving a partial or complete response. This is in contrast to results from previous studies performed in Asian patients. Larger prospective studies are needed to better understand the potential role of TAC in the treatment of lupus nephritis.

« Back to 2018 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/tacrolimus-use-in-hispanic-patients-with-refractory-lupus-nephritis/