TY - JOUR
T1 - Delayed lupus nephritis in the course of systemic lupus erythematosus is associated with a poorer treatment response
T2 - a multicentre, retrospective cohort study in Japan
AU - Nakano, M.
AU - Kubo, K.
AU - Shirota, Y.
AU - Iwasaki, Y.
AU - Takahashi, Y.
AU - Igari, T.
AU - Inaba, Y.
AU - Takeshima, Y.
AU - Tateishi, S.
AU - Yamashita, H.
AU - Miyazaki, M.
AU - Sato, H.
AU - Kanda, H.
AU - Kaneko, H.
AU - Ishii, T.
AU - Fujio, K.
AU - Tanaka, N.
AU - Mimori, A.
N1 - Funding Information:
The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: KF has received consulting fees, speaking fees and/or honoraria from BMS and Mitsubishi Tanabe, Asahikasei, Sanofi, Eli Lilly, Daiichi-Sankyo, Ono, Janssen, AbbVie, Astellas, Eisai, Pfizer, Chugai, Novartis, UCB and Ayumi. KF has received research grants from Takeda, Chugai, BMS, Eli Lilly, Astellas, AbbVie, Tsumura, Asahikasei and Mitsubishi Tanabe. HK has received consulting fees, speaking fees and/or honoraria from Astellas, Eisai, BMS, Pfizer, Daiichi-Sankyo, Janssen, Novartis and Eli Lilly. ST has received consulting fees, speaking fees and/or honoraria from Eisai, AbbVie and Eli Lilly. The Department of Immunotherapy Management, Graduate School of Medicine, The University of Tokyo had courses endowed by Mitsubishi Tanabe, Chugai, Ayumi, Taisho Toyama, NIPPON KAYAKU, UCB and AbbVie.
PY - 2019/8/1
Y1 - 2019/8/1
N2 - Objective: The objective of this study was to investigate possible differences in treatment responses between two categories for the onset of lupus nephritis. Methods: We performed a multicentre, retrospective cohort study of class III–V lupus nephritis patients diagnosed between 1997 and 2014. The renal responses to initial induction therapy were compared between patients who developed lupus nephritis within one year from diagnosis of systemic lupus erythematosus (early (E-) LN) and the remainder (delayed (D-) LN) using the Kaplan–Meier method. We determined the predictors of renal response as well as renal flares and long-term renal outcomes using multivariate Cox regression analyses. Results: A total of 107 E-LN and 70 D-LN patients were followed up for a median of 10.2 years. Log-rank tests showed a lower cumulative incidence of complete response in D-LN compared with E-LN patients. Multivariate analysis identified D-LN (hazard ratio (HR) 0.48, 95% confidence interval (CI) 0.33–0.70), nephrotic syndrome at baseline, and a chronicity index greater than 2 as negative predictors of complete response. D-LN patients were more likely to experience renal flares. D-LN (HR 2.54, 95% CI 1.10–5.83) and decreased renal function were significant predictors of chronic kidney disease at baseline. Conclusion: D-LN was a predictor of poorer treatment outcomes, in addition to renal histology and severity of nephritis at lupus nephritis onset.
AB - Objective: The objective of this study was to investigate possible differences in treatment responses between two categories for the onset of lupus nephritis. Methods: We performed a multicentre, retrospective cohort study of class III–V lupus nephritis patients diagnosed between 1997 and 2014. The renal responses to initial induction therapy were compared between patients who developed lupus nephritis within one year from diagnosis of systemic lupus erythematosus (early (E-) LN) and the remainder (delayed (D-) LN) using the Kaplan–Meier method. We determined the predictors of renal response as well as renal flares and long-term renal outcomes using multivariate Cox regression analyses. Results: A total of 107 E-LN and 70 D-LN patients were followed up for a median of 10.2 years. Log-rank tests showed a lower cumulative incidence of complete response in D-LN compared with E-LN patients. Multivariate analysis identified D-LN (hazard ratio (HR) 0.48, 95% confidence interval (CI) 0.33–0.70), nephrotic syndrome at baseline, and a chronicity index greater than 2 as negative predictors of complete response. D-LN patients were more likely to experience renal flares. D-LN (HR 2.54, 95% CI 1.10–5.83) and decreased renal function were significant predictors of chronic kidney disease at baseline. Conclusion: D-LN was a predictor of poorer treatment outcomes, in addition to renal histology and severity of nephritis at lupus nephritis onset.
KW - Lupus nephritis
KW - delayed lupus nephritis
KW - systemic lupus erythematosus
KW - treatment response
UR - http://www.scopus.com/inward/record.url?scp=85069467715&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85069467715&partnerID=8YFLogxK
U2 - 10.1177/0961203319860200
DO - 10.1177/0961203319860200
M3 - Article
C2 - 31296139
AN - SCOPUS:85069467715
VL - 28
SP - 1062
EP - 1073
JO - Lupus
JF - Lupus
SN - 0961-2033
IS - 9
ER -