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Lupus Nephritis

Change in immunosuppression produces response in refractory lupus nephritis

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Most patients with refractory lupus nephritis (RLN) who change immunosuppression agents see a response to therapy, according to a study.

In this observational bidirectional study, 45 patients with RLN who either failed to improve within 3 months, did not achieve partial renal response (PR) at 6 months, or did not achieve complete renal response (CR) after 2 years of treatment, and were followed for at least 9 months were included.

The median (IQR) SLE duration was three years (2-6 years). Overall, 25 patients had proliferative LN (ISN/RPS class III/IV), with 9 having pure membranous LN (class V).

During a median follow-up period of 15 months, 28 patients had CR, 9 had PR, and 8 had no response to a switch in an immunosuppressive agent.

In more than half of patients there was a histological class transformation, confirmed via repeat renal biopsy with a mean (±SD) biopsy interval of 2 (±1) years.

Immunosuppressive agent used or use sequence did not result in different treatment outcomes or time to attain response.

Three patients died due to infection.

Gururani S, Devarasetti PK, Uppin M, et al. Treatment outcomes in refractory lupus nephritis: Data from an observational study. Lupus. 2021;9612033211033980. doi: 10.1177/09612033211033980. Epub ahead of print. PMID: 34304627.