SAT0177 MULTITARGET THERAPY WITH TACROLIMUS AND MYCOPHENOLATE MOFETIL FOR TREATMENT OF LUPUS NEPHRITIS PRESENTED WITH RAPIDLY PROGRESSIVE GLOMERULONEPHRITIS. (2nd June 2020)

• Record Type: Journal Article
• Authors: Imai, Y.; Ikeuchi, H.; Suwa, J.; Ohishi, Y.; Watanabe, M.; Nakasatomi, M.; Hamatani, H.; Sakairi, T.; Kaneko, Y.; Hiromura, K.
• Is Part Of: Annals of the rheumatic diseases. Volume 79(2020)Supplement 1
• Page Start: 1030
• Page End: 1030
• Publication Date: 2020-06-02
• Subjects: Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/annrheumdis-2020-eular.1775
• Languages: English
• ISSNs: 0003-4967

Abstract

Abstract : Background: Although, most lupus nephritis patients present with chronic glomerulonephritis or nephrotic syndrome, some patients develop rapidly progressive glomerulonephritis (RPGN), which is a clinical syndrome characterized by rapid loss of renal function over a short period of time (days to months). Multitarget therapy using tacrolimus and mycophenolate mofetil (MMF) has been reported to be effective as induction therapy of Class III to Class V lupus nephritis 1 . However, its efficacy on lupus nephritis presented with RPGN has not been well reported. Objectives: We aimed to examine the efficacy of multitarget therapy on lupus nephritis presented with RPGN. Methods: We retrospectively analyzed patients with biopsy-proven lupus nephritis, who clinically showed RPGN, and were treated by multitarget therapy with tacrolimus and MMF in our department. Data were expressed as mean±SD. Results: Five lupus nephritis patients (3 female) with RPGN were treated by multitarget therapy as induction therapy. Mean age was 36.6±13.5 years old. Renal biopsy at treatment revealed Class IV(A) in 2, Class IV(A+C) in 1 and Class IV(A)+V in 2. The percentage of glomerular crescents was 23.1±25.4%. eGFR and proteinuria at the initiation of treatment were 46.8±11.5 mL/min/1.73m 2 and 7.7±3.4 g/gCr, respectively. Patients were initially treated with methylprednisolone pulse therapy followed by 0.8-1.0 mg/kg of prednisolone (PSL), 2-3 mg/day of tacrolimus and 1000 mg/day of MMF. At 6 months, eGFR and proteinuria improved to 72.9±11.3 mL/min/1.73m 2 and 0.19±0.13 g/gCr, respectively. At 12 months, eGFR and proteinuria further improved to 76.8±7.8 mL/min/1.73m 2 and 0.10±0.07 g/gCr, respectively and the dose of PSL was reduced to 6.6±1.5 mg/day. Three patients became positive for cytomegalovirus antigenemia and were successfully treated with antiviral therapy. Conclusion: Multitarget therapy is effective in lupus nephritis even in patients presented with RPGN. References: [1]Liu Z, Zhang H, Liu Z, et al . Multitarget therapy for induction treatment of lupus nephritis: a randomized trial. Ann Int Med 2015; 162: 18-26. Disclosure of Interests: Yoichi Imai: None declared, Hidekazu Ikeuchi Speakers bureau: CHUGAI PHARMACEUTICAL CO., LTD. Astellas Pharma Inc., Junya Suwa: None declared, Yuko Ohishi: None declared, Mitsuharu Watanabe: None declared, Masao Nakasatomi: None declared, Hiroko Hamatani: None declared, Toru Sakairi: None declared, Yoriaki Kaneko Grant/research support from: CHUGAI PHARMACEUTICAL CO., LTD. Astellas Pharma Inc. b, Speakers bureau: CHUGAI PHARMACEUTICAL CO., LTD. Astellas Pharma Inc., Keiju Hiromura Grant/research support from: CHUGAI PHARMACEUTICAL CO., LTD. Astellas Pharma Inc., Speakers bureau: CHUGAI PHARMACEUTICAL CO., LTD. Astellas Pharma Inc.