SAT0256 Multi-target therapy with mizoribine, tacrolimus, and prednisolone in lupus nephritis: analysis of 47 cases. (15th June 2017) - Kawato, R
Abstract : Background: Mizoribine (MZB), an inosine monophosphate dehydrogenase inhibitor, is an effective glucocorticoid-sparing agent for gromerulonephritis and variety of rheumatic diseases. However, its clinical usefulness as multi-target therapy in patients of lupus nephritis has been unclear. Objectives: To evaluate efficacy of multi-target therapy with MZB, tacrolimus (TAC) and prednisolone (PSL) for lupus nephritis. Methods: We extracted all the cases with lupus nephritis treated with PSL, MZB, and TAC during period from 2008/1 to 2016/10. Retrospective medical chart review was performed to collect following data; baseline patient characteristics, dose of PSL, serum creatinine, urine protein, compliment, anti-DNA ab, remission rates, and safety profiles. We define complete remission as urine protein <0.5 g/gCre and normal serum creatinine, partial remission as urine protein decreasing more than 50% at baseline, and <3g/day, and normal serum creatinine or increasing within 15%. Patents' records were followed from the beginning of multi-target treatment to 12 months after. Results: 43 cases (female; n=37, male; n=6, mean age; 37.4 years old) were included for analysis. Of 30 cases who underwent renal biopsy, 10 cases were classified as class IV nephritis, and 7 cases were classified as class III nephritis. Mean urine protein (g/gCr) at baseline, at 3 months, and at 6 months are 1.9, 0.4, and 0.4, respectively. Mean dose of steroid was 32.8 mg/day at baseline, 9.8 mg/day at 3 months, and 8.7 mg/day at 6 month. 79.1% of the patients achieved complete remission at 3 months, and the remission rate was more than 80% at 6 months and later. As for adverse events, 14 cases had some Infection, 3 out of 14 needed antibiotics treatment. Four cases had renal impairment after starting TAC, all of them recovered after stopping or decreasing dose of TAC. Conclusions: Multi-target therapy with MZB, TAC and PSL showed good remission rate, and few severe adverse events. We need the further evaluation of long-term efficacy of the therapy. Disclosure of Interest: None declared