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Cyclosporine maintenance therapy improves outcomes in lupus nephritis
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Prolonged maintenance therapy with cyclosporine was associated with ongoing complete responses in a cohort of patients with lupus nephritis, according to recent findings presented at the EULAR Annual Congress.
The researchers indicated uncertainty remains surrounding the optimal maintenance therapy — cyclosporine, mycophenolate mofetil or azathioprine — for patients with lupus nephritis.
“Our study is the first to compare these three drugs as maintenance therapy in the long term,” Lorenza Maria Argolini, MD, of the department of clinical sciences and community health at the University of Milan, and the department of clinical rheumatology at ASST Istituto Gaetano Pini – CTO Rheumatology in Milan, said.
To compare safety and efficacy outcomes, Argolini and colleagues examined 104 patients who underwent 6 months of induction therapy. This cohort was subsequently broken down into the three treatment arms for maintenance, with 32 patients assigned cyclosporine, 36 assigned mycophenolate mofetil and 36 assigned azathioprine.
Baseline data from the time of induction showed that all three arms were similar in terms of histological classes at renal biopsy, mean serum creatinine, eGFR and proteinuria, and type of induction therapy.
The researchers assessed patients using the primary endpoint of renal response at 1, 5, and 10 years. Complete response was defined as eGFR > 60mL/min and proteinuria < 0.5 g/die, while partial response was defined as eGFR > 60 mL/min and proteinuria > 0.5/die and no response was defined as eGFR < 60 mL/min.
At the outset of the maintenance period, cyclosporine was associated with a 28.2% complete response rate, a 59.3% partial response rate, and a 12.5% no response rate. For mycophenolate mofetil, half the cohort reached a complete response, compared with 44.5% partial responders and 5.5% no responders. The rates for azathioprine were 38.8% complete response, 55.2% partial response, and 6% no response.
Findings at 1 year showed that the complete response rate for cyclosporine increased to 72%, compared with an increase in complete responders to 64% for mycophenolate mofetil and 44.2% for azathioprine. By 5 years, cyclosporine yielded a complete response rate of 81.5%, compared with 81% for mycophenolate mofetil and 86% for azathioprine. Ten-year complete response rates were 84.5% for cyclosporine, 72% for mycophenolate mofetil, and 70% for azathioprine.
The researchers noted that the number and type of flares experienced by patients in the cohort were similar across treatment arms.
“Of interest are the results achieved in the [cyclosporine] group where, despite worse clinical conditions at the beginning of maintenance therapy, we observed a rapid achievement of remission in the great majority of patients,” Argolini said. —by Rob Volansky
Reference:
Argolini LM, et al. OP0046. Presented at: EULAR Annual Congress; June 12-15, 2019; Madrid.
Disclosure: Argolini reports no relevant financial disclosures.