AB0525 Identification of effective parameters informing the selection of intravenous cyclophosphamide versus mycophenolate mofetil for induction therapy for lupus nephritis. (12th June 2018) - Mino, N.
Abstract : Background: The 2012 EULAR recommendations gave equal weight to intravenous cyclophosphamide (IVCY) and mycophenolate mofetil (MMF) as the induction therapy for class III/IV lupus nephritis (LN). However, there are no effective parameters that could inform the choice the induction therapy (IVCY or MMF) in individual cases. Objectives: This study examined the patient characteristics that determine the most appropriate treatment for LN: IVCY or MMF. Methods: We retrospectively examined 29 patients with LN who received induction therapy with IVCY (n=16) or MMF (n=13) between January 1994 and December 2015. Their baseline characteristics and the complete response (CR) rate at week 24 were analysed. CR was defined as a urine protein:creatinine ratio <0.5 g/gCre with normal urine sediment. Results: At baseline, the time since diagnosis of systemic lupus erythematosus (SLE) was longer in the IVCY group than the MMF group (4.8±6.4 vs. 1.3±2.5 years, p=0.06) and the IVCY group had more frequent flares (1.9±2.4 vs. 0.7±1.1 times, p=0.08); however, the differences were not significant. Moreover, there was no difference in age, sex, complement levels, anti-dsDNA antibody titers, anti-Sm/RNP antibody positivity rates, proteinuria, or rate of abnormality in urine sediment at baseline between the two groups. CR was achieved at week 24 in 11/16 patients (69%) in the IVCY group and 9/13 patients (69%) in the MMF group. Considering the 20 patients who achieved CR at week 24, univariate analyses revealed that in addition to a longer time since diagnosis of SLE (4.5±6.6 vs. 1.0±1.7 years, p=0.12) and more frequent flares (1.9±2.8 vs. 0.6±1.0 times, p=0.16), the anti-RNP antibody positivity rate was higher (OR 8.15; p=0.07) in the IVCY group. Furthermore, the positivity rate of anti-RNP antibody differed significantly (OR 12.9; p=0.03) in the multivariate analysis. Conclusions: Although IVCY and MMF are equivalent treatment options for LN, IVCY might be more effective for patients with anti-RNP antibody. Reference: [1] George K, Bertsias, et al. Annals of the Rheumatic Diseases2012;71:1771–1782. Disclosure of Interest: None declared