AB0574 Renal activity patterns and therapeutics in lupus nephritis observations in 5 mexican rheumatology centres
Authors: G. Pickens, D.A. Herrera-van Oostdam, F. Irazoque-Palazuelos, S. Cerpa-Cruz, M.A. Saavedra-Salinas, C. Mendoza-Pinto, C. Abud-Mendoza
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Lupus nephritis (LN) develops in 40%–60% of Systemic Erythematous Lupus (SLE) patients; 45% don't achieve complete response or eventually relapse and 10%–20% progress to end stage renal disease. <h3>Objectives</h3> Describe renal activity patterns and therapeutic schemes employed in 5 Mexican Rheumatology Centres. <h3>Methods</h3> Retrospective analysis of renal activity in 193 patients with LN with ≥6 months follow-up. If follow-up was ≤1 year, response was classified as complete (CR), partial (PR) or no response (NR). If follow up was &gt;1 year, response was classified as one of the following patterns: persistent inactive (PI), relapsing-remitting (RR), chronic active (CA) and mixed. <h3>Results</h3> Biopsy was available in 166 subjects (86.01%): class IV (42.77%), III(23.49%), V(10.24%), II(9.03%). The most prevalent schemes were CYC+MMF 46.6%, only CYC 18.13%, only MMF 12.4%, CYC+MMF+ TAC 9.84%. Thirty eight patients had follow-up ≤1 year with the following response: CR 16 (42.1%), NR 13 (34.21%) y PR 9 (25.7%). One hundred and fifty five patients had &gt;1 year follow-up with the following activity patterns: PI 55 (35.48%), RR 38 (24.51%), CA 31 (20%), mixed 31 (20%). We then compared patients whose therapeutic schemes were classified as the National Institutes of Health regime (n=109) (as considered by the treating physician) to those with different therapeutic schemes. We observed a higher final GFR (100±39.2 SD VS 87.1±37.9 SD, p=0.029) and more frequent CYC use (106±100 SD VS 37±49.3 SD, p&lt;0.0001) in the NIH group. There weren't statistically significant concerning renal response or activity patterns. Although treating physicians stated they had used the NIH regime in 57.9%, 64.03% actually received CYC+MMF and 11.4% CYC+MMF+ TAC. We then compared the group that received CYC monotherapy to the groups that received CYC+MMF and CYC+MMF+ TAC and did not observe any statistically significant differences. <h3>Conclusions</h3> The most prevalent renal activity patterns were those that translated intermittent of continuous activity (64.51%). Strict adherence to the original NIH regime is questionable, most subjects actually received CYC+MMF at some point. We did not observe any statistically significant superiority of renal outcomes of combination therapy over CFM monotherapy. Limitations: preliminary initial analysis, heterogeneous information and missing data. <h3>References</h3> [1] Yurkovich M, Vostretsova K, Chen W, Aviña-Zubieta JA. Overall and cause-specific mortality in patients with systemic lupus erythematosus: A meta-analysis of observational studies. Arthritis Care Res. (Hoboken)2014Apr;66(4):608–16. [2] Mok CC, Kwok RCL, Yip PSF. Effect of renal disease on the standardized mortality ratio and life expectancy of patients with systemic lupus erythematosus. Arthritis Rheum 2013 Aug;65(8):2154–60. <h3>Disclosure of Interest</h3> None declared