Lupus Nephritis

Leflunomide shows potential as maintenance therapy for lupus nephritis

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The immunosuppressant leflunomide was found to be non-inferior to azathioprine for maintenance therapy of lupus nephritis (LN), according to a study.

A total of 270 patients with LN received 6-9 months of induction therapy with intravenous cyclophosphamide plus glucocorticoids and those that achieved complete response (CR) or partial response (PR) were randomized to receive prednisone in combination with leflunomide (n = 108) or azathioprine (n = 107). as maintenance therapy for 36 months.

Amongst leflunomide- and azathioprine-treated patients, 15.7% (n = 17) and 17.8% (n = 19), respectively, experienced kidney flares.

Time to kidney flare was 16 months in the leflunomide group versus 14 months in the azathioprine group, which was not statistically different.

Similar improvements in 24-hour proteinuria, serum creatinine, serum albumin, serum C3, and serum C4 were noted. There were 2 patients in the azathioprine group and 1 patient from the leflunomide group that had extrarenal flares.

The incidence of adverse events was 56.5% in the leflunomide group and 58.9% in the azathioprine group.

Fu Q, Wu C, Dai M, et al. Leflunomide versus azathioprine for maintenance therapy of lupus nephritis: a prospective, multicentre, randomised trial and long-term follow-up. Ann Rheum Dis. 2022; doi: 10.1136/ard-2022-222486. Epub ahead of print. PMID: 35788493.