ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 0663

Treatment Patterns and the Prevalence of Kidney Biopsy-Confirmed LN in Patients with SLE and Proteinuria: A Multicenter Cohort Study

Arushi Ramnarain1, Xiaomeng Xu2, Joanna Kent3, Sagar Jagtiani4, Worawit Louthrenoo5, Laniyati Hamijoyo6, Shue-Fen Luo7, Yi-Hsing Chen8, Jiacai Cho9, Chiu Wai Shirley Chan10, Sandra Navarra11, Haihong Yao12, Lydia Pok13, BMDB Basnayake14, Zhuoli Zhang15, Madelynn Chan16, Sang-Cheol Bae17, Yasuhiro Katsumata18, Jun Kikuchi19, Sean O'Neill20, Fiona Goldblatt21, Yih Jia Poh22, Mark Sapsford23, Nicola Tugnet24, Kristine Pek Ling Ng25, Cherica Tee26, Yoshiya Tanaka27, Mandana Nikpour28, Alberta Hoi29, Eric Morand30 and Rangi Kandane-Rathnayake31, 1Monash Health, Melbourne, Victoria, Australia, 2GSK, Value, Evidence & Outcomes, Singapore, Singapore, 3Monash University, Department of Nephrology, Monash Health and Department of Medicine, Melbourne, Australia, 4Glaxo Smith Kline, Singapore, Singapore, 5Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand, Chiang Mai, Thailand, 6Hasan Sadikin Hospital, Jakarta Selatan, Indonesia, 7Chang Gung Memorial Hospital, Taipei, Taiwan, 8Taichung Veterans General Hospital, Taichung, TW, Taichung, Taiwan (Republic of China), 9National University Hospital, Singapore, Singapore, 10Division of Rheumatology and Clinial Immunology, Department of Medicine, the University of Hong Kong, Hong Kong, Hong Kong, China, 11University of Santo Tomas, Manila, Philippines, 12People's Hospital, Peking University Health Science Center, Department of Rheumatology and Immunology, Beijing, China, 13University of Malaya Medical Center, Department of Medicine, Faculty of Medicine,, Kuala Lumpur, Malaysia, 14Teaching Hospital, Kandy, Sri Lanka, 15Peking University First Hospital, Beijing, China, 16Tan Tock Seng Hospital, Singapore, Singapore, 17Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea, 18Tokyo Women's Medical University School of Medicine, Tokyo, Japan, 19Keio University School of Medicine, Tokyo, Japan, 20Liverpool Hospital; Royal North Shore Hospital; University of New South Wales and the University of Sydney, Sydney, New South Wales, Australia, 21Flinders Medical Centre, Adelaide, Australia, 22SingHealth, Singapore, Singapore, 23WDHB, Auckland, New Zealand, 24Auckland District Health Board, Auckland, New Zealand, 25Health New Zealand, Auckland, New Zealand, 26Department of Pediatrics, College of Medicine, University of the Philippines, Manila, Philippines, 27Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan, 28The University of Sydney, Melbourne, Victoria, Australia, 29Monash Health, Monash University, Melbourne, AU, Melbourne, Victoria, Australia, 30School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia, 31Monash University, Clayton, Victoria, Australia

Meeting: ACR Convergence 2024

Keywords: , , ,

Session Information

Date: Saturday, November 16, 2024

Title: SLE – Treatment Poster I

Session Type: Poster Session A

Session Time: 10:30AM-12:30PM

Background/Purpose: LN is a common and severe manifestation of SLE. Although proteinuria is a useful diagnostic indicator, kidney biopsy is necessary for definitive diagnosis and to guide management. Current utilization of kidney biopsy in patients with SLE with proteinuria varies globally. We examined treatment patterns and the prevalence of kidney biopsy in patients with active LN.

Methods: Adult patients with criteria-defined SLE enrolled in a multinational observational cohort were studied prospectively between 2013 and 2020. The study cohort was limited to patients with active LN, defined as per SLEDAI criteria (proteinuria >0.5 g/24 h or >0.05 g/mmol with or without hematuria or active urine sediment) at least once during the study period. The first visit with proteinuria during the observation period was defined as the index visit. Patients with less than two visits or exposure to biological agents were excluded. Characteristics of patients with a history of kidney biopsy (KB+) and those with no kidney biopsy (KB-) were compared using Wilcoxon rank-sum (numerical variables) and Chi-square (categorical variables) tests.

Results: In total, 1180 patients with LN (91.8% females and 93.7% of Asian ethnicity) followed over a median of 2.7 years (interquartile range [IQR]: 1.0, 5.0) were studied. Of these, 90.9% (n=1073) received glucocorticoids (GC; median [IQR] daily dose = 9.0mg [5.0, 20]), 63.1% (n=745) received antimalarials (AM), and 72.3% (n=853) received immunosuppressants (IS) during the study period (Table 1). A kidney biopsy had been performed in 38.8% (n=458) of the study cohort (KB+). Compared with the KB+ patients, KB- patients were more likely to be of Asian ethnicity (97.8% vs 87.3%, p< 0.001) and from a country with a gross domestic product (GDP) < Int. $20,000 (53.9% vs 27.9%, p< 0.001; Table 1 & Figure 1). While proteinuria levels (g/mmol) were statistically higher in KB+ patients, (KB- 0.1 (0.1, 0.2) vs KB+ 0.1 (0.1, 0.3), p=0.031), estimated glomerular filtration rate (eGFR) was comparable between the groups. The proportion of patients who received AM and IS was significantly higher in the KB+ versus KB- group (AM: 68.8% vs 59.6%, p< 0.001; IS: 75.5% vs 70.2%, p=0.046). In contrast, a lower proportion of patients in the KB+ versus KB- group received GC (88.9% vs 92.2%, p=0.049). Other clinical indicators were similar between both groups.

Conclusion: In a multinational cohort of patients with SLEDAI-defined LN, kidney biopsy rates varied greatly between countries, despite similar eGFR and proteinuria levels, and were linked to differences in treatment exposure, highlighting variations in international practice.

Supporting image 1

Figure 1. Country distribution of study participants, stratified by GDP per purchasing power parity per capita.

Supporting image 2

Table 1. Demographics, medications use, and clinical indicators of study participants, stratified by kidney biopsy performance.

Disclosures: A. Ramnarain: None; X. Xu: GlaxoSmithKlein(GSK), 3; J. Kent: None; S. Jagtiani: GlaxoSmithKlein(GSK), 3; W. Louthrenoo: None; L. Hamijoyo: None; S. Luo: None; Y. Chen: None; J. Cho: None; C. Chan: None; S. Navarra: Astellas, 6, AstraZeneca, 6, Biogen, 2, Boehringer-Ingelheim, 2, GlaxoSmithKlein(GSK), 6, Novartis, 6, Pfizer, 6; H. Yao: None; L. Pok: None; B. Basnayake: None; Z. Zhang: None; M. Chan: None; S. Bae: None; Y. Katsumata: AstraZeneca, 6, GlaxoSmithKlein(GSK), 6; J. Kikuchi: None; S. O'Neill: None; F. Goldblatt: None; Y. Poh: None; M. Sapsford: None; N. Tugnet: None; K. Ng: None; C. Tee: None; Y. Tanaka: AbbVie, 6, Asahi-kasei, 6, Astellas, 6, AstraZeneca, 6, Boehringer Ingelheim, 5, 6, Chugai, 5, 6, Daiichi Sankyo, 6, Eisai, 6, Gilead, 6, GSK, 6, Lilly, 6, Pfizer, 6, Taisho, 5, 6, UCB, 6; M. Nikpour: AstraZeneca, 2, 5, 6, Boehringer-Ingelheim, 2, 5, 6, Bristol-Myers Squibb(BMS), 5, GlaxoSmithKlein(GSK), 6, Janssen, 2, 5, 6; A. Hoi: AbbVie/Abbott, 6, AstraZeneca, 5, Australian Rheumatology- Association, 4, 12, Treasurer, Eli Lilly, 6, EUSA Pharma, 2, Limbic, 6, Moose Republic, 6, Novartis, 6; E. Morand: AbbVie, 5, Amgen, 5, AstraZeneca, 1, 2, 5, 6, Biogen, 2, 5, Bristol Myers Squibb, 2, 5, Dragonfly, 2, Eli Lilly, 5, EMD Serono, 2, 5, Genentech, 2, 5, Gilead, 2, GSK, 2, 5, Janssen, 5, Novartis, 2, 5, RemeGen, 2, Roche, 5, 6, Takeda, 2, 5, UCB, 5, Zenas, 2; R. Kandane-Rathnayake: GlaxoSmithKline(GSK), 5, Janssen, 5, Novartis, 5.

To cite this abstract in AMA style:

Ramnarain A, Xu X, Kent J, Jagtiani S, Louthrenoo W, Hamijoyo L, Luo S, Chen Y, Cho J, Chan C, Navarra S, Yao H, Pok L, Basnayake B, Zhang Z, Chan M, Bae S, Katsumata Y, Kikuchi J, O'Neill S, Goldblatt F, Poh Y, Sapsford M, Tugnet N, Ng K, Tee C, Tanaka Y, Nikpour M, Hoi A, Morand E, Kandane-Rathnayake R. Treatment Patterns and the Prevalence of Kidney Biopsy-Confirmed LN in Patients with SLE and Proteinuria: A Multicenter Cohort Study [abstract]. Arthritis Rheumatol. 2024; 76 (suppl 9). https://acrabstracts.org/abstract/treatment-patterns-and-the-prevalence-of-kidney-biopsy-confirmed-ln-in-patients-with-sle-and-proteinuria-a-multicenter-cohort-study/. Accessed .

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