In patients with lupus nephritis (LN), greater length of time needed to achieve remission and increased number of flares contributed to declining estimated glomerular filtration (eGFR) rates, while increased length of time on immunosuppressants after remission prevented renal decline, according to study results presented at the European Alliance of Associations for Rheumatology (EULAR) Congress 2022, held from June 1 to 5, 2022 in Copenhagen, Denmark.

Researchers obtained data on 418 eligible patients treated for LN at the Toronto Lupus Clinic from the long-term database. They followed these patients for 5 years to determine how number of flares, length of time to remission, and length of time on immunosuppressants after remission affected eGFR rate.

Of the 418 patients, 209 (50%) achieved remission in 1 year, 102 (24.4%) achieved remission in 2 to 3 years, 70 (16.7%) after 3 years, and 37 (8.9%) never went into remission. Most patients (62.4%) experienced 2 or more flares, 19.6% never flared, and 18% experienced 1 flare during the 5-year follow-up period.


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Decreased eGFR rate significantly correlated with longer time to remission (over 3 years) or no remission. Patients who achieved remission between 2 to 3 years after diagnosis of LN did not demonstrate significantly decreased renal function during this time.

Patients who experienced 2 or more flares also developed accelerated renal dysfunction as evidenced by decreased eGFR rate over time, whereas patients who experienced 1 or no flares did not.

The researchers observed that length of time treated with immunosuppressants after complete remission correlated with improved renal function by effectively guarding against eGFR rate decline.

The study authors concluded, “Our findings emphasize the importance of rapid remission and flare prevention by prolonged maintenance treatment with immunosuppressives to optimize renal outcomes.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Reference

Tselios K, Gladman DD, Su J, Urowitz MB. Impact of time to remission, flares, and time on immunosuppressives on the estimated glomerular filtration rate in lupus nephritis. Presented at: EULAR Congress 2022; June 1-4, 2022; Copenhagen, Denmark Abstract #OP0140.