Treatment Patterns in Latin American Patients with Lupus Nephritis over a 20-year Period

Rosana quintana¹, Jose Gomez Puerta², Guillermina Harvey³, Marina Scolnik⁴, Nidia Meras⁵, Cintia Otaduy⁶, Maria Salinas⁷, Valeria Arturi⁸, Maria Sattler⁹, Rosa Serrano Morales¹, Luciana Gonzalez Lucero¹⁰, Wilfredo Grageda¹¹, Nicolas Perez¹², Cecilia Nora Pisoni¹³, Simone Appenzeller¹⁴, Ana Silva¹⁵, Odirlei Andre Monticielo¹⁶, Henrique Moriz¹⁷, Francinne Ribiero¹⁸, Emily Figueiredo Neves Yuki Yuki¹⁹, Edgard Neto²⁰, Iris Guerra²¹, Paula Burgos²², Milena Mimica²³, Gustavo Aroca²⁴, Gabriel Tobon²⁵, Luis Gonzalez²⁶, Gerardo Quintana-López²⁷, Andres Bonfanti²⁴, RAFAEL LOPEZ²⁸, Luis Jara Quezada²⁹, Margarita Portela-Hernandez³⁰, HILDA FRAGOSO LOYO³¹, Luis H Silveira³², Ignacio Garcia-De La Torre³³, Carlos Abud-Mendoza³⁴, Jorge Esquivel-Valerio³⁵, Jonathan Losanto³⁶, Astrid Paats³⁷, JORGE CIEZA CALDERON³⁸, Manuel Ugarte-Gil³⁹, Katiuzka Zuniga Corrales⁴⁰, Roberto Munoz⁴¹, Ernesto Cairoli⁴², Gonzalo Silveira⁴³, Luis Catoggio⁴⁴, Ashley Orillion⁴⁵, Chetan Karyekar⁴⁶, Federico Zazzetti⁴⁷ and Bernardo A. Pons-Estel⁴⁸, ¹Grupo Oroño. Centro Regional de Enfermedades Autoinmunes y Reumaticas (GO-CREAR), Rosario, Argentina, ²Hospital Clinic, University of Barcelona, Barcelona, Spain, ³Instituto de Investigaciones Teóricas y Aplicadas. Facultad de Ciencias Económicas y Estadistica. Universidad Nacional de Rosario, Rosario, Argentina, ⁴Hospital Italiano de Buenos Aires, Buenos Aires, Argentina, ⁵Hospital Italiano de Córdoba, Córdoba, Argentina, ⁶Hospital Córdoba, Cordoba, Argentina, ⁷Hospital Privado Universitario de Córdoba, Cordoba, Argentina, ⁸Hospital HIGA San Martín, La Plata, Argentina, ⁹Sanatorio Británico, Cordoba, Argentina, ¹⁰Janssen Cilag Farmaceutica SA, Tucuman, Argentina, ¹¹Hospital General de Agudos J.M. Ramos Mejía, Buenos Aires, Argentina, ¹²Instituto de Investigaciones Médicas Alfredo Lanari, Buenos Aires, Argentina, ¹³CEMIC, Buenos Aires, Argentina, ¹⁴Hospital das Clínicas da Universidade Estadual de Campinas, Campinas, Brazil, ¹⁵UFG, GOIANIA, Goias, Brazil, ¹⁶Serviço de Reumatologia do Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil, ¹⁷Hospital das Clinicas, Universidade Federal de Pernambuco, Pernambuco, Brazil, ¹⁸Hospital Universitario Pedro Ernesto, UERJ, Rio de Janeiro, Brazil, ¹⁹Hospital Das Clinicas da Faculdade de Medicina da USP, São Paulo, Brazil, ²⁰UNIFESP, São Paulo, Brazil, ²¹Hospital del Salvador, Santiago, Chile, ²²Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile, ²³Universidad San Sebastián, Santiago, Chile, ²⁴Clínica de la Costa Ltda., Barranquilla, Colombia, ²⁵Fundación Valle del Lili, Cali, Colombia, ²⁶Universidad de Antioquia, Medellin, Colombia, ²⁷Reumavance Group, Rheumatology section, Department of Internal Medicine, Fundación Santa Fe de Bogotá University Hospital; Department of Internal Medicine, School of Medicine, Universidad Nacional de Colombia; Department of Internal Medicine, School of Medicine, Universidad de Los Andes, Bogota, Colombia, ²⁸Hospital Luis Vernaza, Guayaquil, Ecuador, ²⁹Centro Médico La Raza, Mexico City DF, Mexico, ³⁰IMSS, Mexico Df, Mexico, ³¹INCMNSZ, Tlalpan, Mexico, ³²Instituto Nacional de Cardiologia, Mexico City, Mexico, ³³Centro de Estudios de Investigación Básica y Clínica, S.C., Guadalajara, Mexico, ³⁴Hospital Central “Dr Ignacio Morones Prieto”, Unidad Regional de Reumatología y Osteoporosis, Hospital Central and Facultad de Medicina de la Universidad Autónoma de San Luis Potosí, San Luis Potosí, Mexico, ³⁵University Hospital Dr. Jose Eleuterio Gonzalez, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico, ³⁶Hospital de Clínicas I, San Lorenzo, Paraguay, ³⁷Hospital de Clinicas, Asuncion, Paraguay, ³⁸Hospital Nacional Edgardo Rebagliatti Martins, Lima, Peru, ³⁹Hospital Guillermo Almenara Irigoyen, Essalud/Universidad Científica del Sur, Lima, Peru, ⁴⁰Hospital Cayetano Heredia, Lima, Peru, ⁴¹Hospital Docente Padre Billini, Santo Domingo, Dominican Republic, ⁴²Autoimmune Diseases Unit, Centro Asistencial del Sindicato Médico del Uruguay (CASMU) and Hospital Evangélico, Montevideo, Uruguay, ⁴³Hospital Señor del Milagro, Salta, Argentina, ⁴⁴Hospital Italiano de Buenos Aires, Olivos, Argentina, ⁴⁵Global Commercial Strategic Organisation, Johnson and Johnson, Horsham, PA, ⁴⁶Janssen R&D, Spring House, PA, ⁴⁷Medical Affairs, Jan-Cil Argentina, Buenos Aires, Argentina, ⁴⁸Grupo Oroo - Centro Regional de Enfermedades Autoinmunes y Reumticas (GO-CREAR), Rosario, Argentina

Meeting: ACR Convergence 2021

Keywords: Access to care, Cohort Study, Lupus nephritis, treatments

Session Information

Date: Tuesday, November 9, 2021

Title: SLE – Treatment Poster (1732–1772)

Session Type: Poster Session D

Session Time: 8:30AM-10:30AM

Background/Purpose: Systemic lupus erythematosus (SLE) is a complex and heterogeneous autoimmune disease. Over the last decade, changes have occurred in the treatment of these patients, related to the inclusion of new agents, the strong recommendation to use lower doses of glucocorticoids and data favoring the use of antimalarials. The aim of this study is to describe lupus nephritis (LN) treatments in two Latin American cohorts over a 20-year period.

Methods: Two cohorts from the Latin American Lupus Study Group (GLADEL, Grupo Latino Americano De Estudio del Lupus) have been evaluated. The first, GLADEL 1.0, is an inception cohort started in 1997 that up to 2002 enrolled 1,480 patients; the second, GLADEL 2.0, is an observational prevalent and incident cohort initiated in 2019 that so far has enrolled 880 patients. In both cohorts, LN has been defined by kidney biopsy according to the International Society of Nephrology and Renal Pathology Society, and includes two groups: non-proliferative (class II/V) and proliferative (III/IV). The different therapeutic regimens used in both cohorts are described. In addition, the sociodemographic and serological variables and the histological characteristics are compared. Numeric variables are reported as medians (interquartile ranges) and compared using Mann-Whitney test; categorical variables are reported as frequencies (percentages) and compared using Chi-square or Fisher test, as appropriate.

Results: A total of 546 patients with LN diagnosis have been included; 362 from GLADEL 1.0 and 184 from GLADEL 2.0. One hundred and two and 35 patients form the respective cohorts were classified into LN-Class II/V; 260 and 149 patients were classified into LN-Class III/IV (Table1). LN patients from GLADEL 2.0 had longer disease duration, [months, median (Q1-Q3)] [73 (33-141) vs. 54 (32-75), p< 0.0001] compared to GLADEL 1.0. The comparison of the sociodemographic variables showed that patients from GLADEL 2.0 have a higher proportion of Mestizos (71.2% vs. 44.4%), had a higher proportion of higher and middle socioeconomic status (19.6% vs. 5.5%, and 42.9% vs. 32.0%, respectively, p< 0.0001), and a higher level of formal education [years, median (Q1-Q3)] (13 (11-16) vs. 11 (7-139), p< 0.0001)]. In GLADEL 1.0, a higher number of patients with LN-Class III/IV had Hypocomplementemia (65.4% vs. 43.6%, p< 0.0001), and anti-dsDNA antibodies (58.1% vs 36.2), p< 0.0001) when compared with patients from GLADEL 2.0.

In GLADEL 2.0 a statistically significant increase in the use of antimalarials and decrease in the use of IV cyclophosphamide were observed. Azathioprine showed the same tendency as IV cyclophosphamide but no statistical significance was reached. As expected, new drugs were incorporated into the treatment scheme, mainly mycophenolate mofetil and less frequently tacrolimus and rituximab.

Conclusion: The management of LN in Latin America has changed over the last 20 years. New treatments have been included, there has been a trend towards a high use of mycophenolate mofetil and a decrease of cyclophosphamide. A higher use of antimalarials over time has also been observed.

Table 1 Comparison of the different treatments used in both GLADEL cohorts

Disclosures: R. quintana, None; J. Puerta, Abbvie, 6, BMS, 6, GSK, 6, Pfizer, 6, Lilly, 6, Galapagos, 1, MSD, 6, Sanofi, 1, Roche, 6; G. Harvey, None; M. Scolnik, Pfizer, 6, Lilly, 6, Roche, 6, Bristol Myers Squibb, 6, Glaxo, 5, 6, Janssen, 5, 6; N. Meras, None; C. Otaduy, None; M. Salinas, None; V. Arturi, None; M. Sattler, None; R. Serrano Morales, None; L. Gonzalez Lucero, None; W. Grageda, None; N. Perez, None; C. Pisoni, None; S. Appenzeller, None; A. Silva, None; O. Andre Monticielo, GSK, 6, GSK, 2; H. Moriz, None; F. Ribiero, None; E. Yuki, None; E. Neto, GlaxoSmithKline (GSK), 6, Novartis, 6, BracePharma, 6; I. Guerra, None; P. Burgos, None; M. Mimica, None; G. Aroca, None; G. Tobon, None; L. Gonzalez, None; G. Quintana-López, None; A. Bonfanti, None; R. LOPEZ, None; L. Jara Quezada, None; M. Portela-Hernandez, None; H. FRAGOSO LOYO, None; L. Silveira, None; I. Garcia-De La Torre, None; C. Abud-Mendoza, Lilly, 6, GlaxoSmithKline, 6, Pfizer, 6; J. Esquivel-Valerio, None; J. Losanto, None; A. Paats, None; J. CIEZA CALDERON, None; M. Ugarte-Gil, Pfizer, 5, Janssen, 5; K. Zuniga Corrales, None; R. Munoz, None; E. Cairoli, None; G. Silveira, ROCHE, 12, e-eular 2020 inscription, ROCHE, 12, e-eular 2021 inscription, SCIENZA Uruguay, 12, SAR e-congress 2020 inscription; L. Catoggio, Boehringer Ingelheim, 6; A. Orillion, None; C. Karyekar, Janssen Global Services, LLC, 3, 11; F. Zazzetti, Janssen, 3; B. Pons-Estel, Janssen, 5, Glaxo Smith Kline, 6.

To cite this abstract in AMA style:

quintana R, Puerta J, Harvey G, Scolnik M, Meras N, Otaduy C, Salinas M, Arturi V, Sattler M, Serrano Morales R, Gonzalez Lucero L, Grageda W, Perez N, Pisoni C, Appenzeller S, Silva A, Andre Monticielo O, Moriz H, Ribiero F, Yuki E, Neto E, Guerra I, Burgos P, Mimica M, Aroca G, Tobon G, Gonzalez L, Quintana-López G, Bonfanti A, LOPEZ R, Jara Quezada L, Portela-Hernandez M, FRAGOSO LOYO H, Silveira L, Garcia-De La Torre I, Abud-Mendoza C, Esquivel-Valerio J, Losanto J, Paats A, CIEZA CALDERON J, Ugarte-Gil M, Zuniga Corrales K, Munoz R, Cairoli E, Silveira G, Catoggio L, Orillion A, Karyekar C, Zazzetti F, Pons-Estel B. Treatment Patterns in Latin American Patients with Lupus Nephritis over a 20-year Period [abstract]. Arthritis Rheumatol. 2021; 73 (suppl 9). https://acrabstracts.org/abstract/treatment-patterns-in-latin-american-patients-with-lupus-nephritis-over-a-20-year-period/. Accessed .

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