Disease modification achievement in patients with lupus nephritis in a real-life setting: mission impossible?
Objective A preliminary definition of disease modification (DM) in lupus nephritis (LN) was recently developed focusing on long-term remission and damage prevention, with minimal treatment-associated toxicity. We aimed to further specify aspects of DM criteria in LN, assess DM achievement in a real-...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2023-04-01
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| Series: | RMD Open |
| Online Access: | https://rmdopen.bmj.com/content/9/2/e003158.full |
| _version_ | 1827893215681839104 |
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| author | Maria G Tektonidou Petros P Sfikakis John Boletis Smaragdi Marinaki Alexandros Panagiotopoulos Ioannis Michelakis Eleni Kapsia |
| author_facet | Maria G Tektonidou Petros P Sfikakis John Boletis Smaragdi Marinaki Alexandros Panagiotopoulos Ioannis Michelakis Eleni Kapsia |
| author_sort | Maria G Tektonidou |
| collection | DOAJ |
| description | Objective A preliminary definition of disease modification (DM) in lupus nephritis (LN) was recently developed focusing on long-term remission and damage prevention, with minimal treatment-associated toxicity. We aimed to further specify aspects of DM criteria in LN, assess DM achievement in a real-world setting and examine potential DM predictors and long-term outcomes.Methods We collected clinical/laboratory and histological inception cohort data from biopsy-proven LN patients (82% females) with ≥72 months follow-up at two joint academic centres. Specific criteria for 24-hour proteinuria, estimated glomerular filtration rate (eGFR), renal flares and glucocorticoids dose were set at three time frames (months 0–12, 13–60 and 72) to assess DM. In the first model, DM was achieved if patients fulfilled all four criteria at all three time frames (achievers). In the second model, the continued glucocorticoids reduction criterion was excluded. Logistic regression analyses were performed. Possible different trends in DM achievement between past and recent decades were also investigated.Results DM was achieved by 60% of patients, increased to 70% when glucocorticoids excluded from DM criteria. 24-hour proteinuria at 9 months predicted DM achievement (OR 0.72, 95% CI 0.53 to 0.97, p=0.03), but none of baseline characteristics. Among patients with >72 month follow-up, non-achievers had worse renal outcomes (flares, >30% proteinuria increase, eGFR decline) than achievers at the end of follow-up (median 138 months). Patients diagnosed between 1992 and 2005 were found to have significantly lower percentages of DM achievement and met less often the glucocorticoids dose reduction criterion in all three time frames, compared with those diagnosed between 2006 and 2016 (p=0.006 and p<0.01, respectively).Conclusions DM was achieved by only 60% of LN patients in a real-life setting, partly due to lack of glucocorticoids dose target attainment, while DM failure was associated with worse long-term renal outcomes. This may imply limitations in the effectiveness or implementation of current LN treatments, supporting the need for novel therapeutic strategies. |
| first_indexed | 2024-03-12T21:50:38Z |
| format | Article |
| id | doaj.art-dd717e6429014c15af0e605979fc0ec4 |
| institution | Directory Open Access Journal |
| issn | 2056-5933 |
| language | English |
| last_indexed | 2024-03-12T21:50:38Z |
| publishDate | 2023-04-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | RMD Open |
| spelling | doaj.art-dd717e6429014c15af0e605979fc0ec42023-07-26T04:25:07ZengBMJ Publishing GroupRMD Open2056-59332023-04-019210.1136/rmdopen-2023-003158Disease modification achievement in patients with lupus nephritis in a real-life setting: mission impossible?Maria G Tektonidou0Petros P Sfikakis1John Boletis2Smaragdi Marinaki3Alexandros Panagiotopoulos4Ioannis Michelakis5Eleni Kapsia6Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Joint Academic Rheumatology Program, Laiko Hospital, Medical School, National and Kapodistrian University, Athens, GreeceRheumatology Unit, First Department of Propaedeutic Internal Medicine, Joint Academic Rheumatology Program, Laiko Hospital, Medical School, National and Kapodistrian University, Athens, GreeceDepartment of Nephrology and Renal Transplantation, Laiko Hospital, Medical School, National and Kapodistrian University, Athens, GreeceDepartment of Nephrology and Renal Transplantation, Laiko Hospital, Medical School, National and Kapodistrian University, Athens, GreeceRheumatology Unit, First Department of Propaedeutic Internal Medicine, Joint Academic Rheumatology Program, Laiko Hospital, Medical School, National and Kapodistrian University, Athens, GreeceMedical School, National and Kapodistrian University, Athens, GreeceDepartment of Nephrology and Renal Transplantation, Laiko Hospital, Medical School, National and Kapodistrian University, Athens, GreeceObjective A preliminary definition of disease modification (DM) in lupus nephritis (LN) was recently developed focusing on long-term remission and damage prevention, with minimal treatment-associated toxicity. We aimed to further specify aspects of DM criteria in LN, assess DM achievement in a real-world setting and examine potential DM predictors and long-term outcomes.Methods We collected clinical/laboratory and histological inception cohort data from biopsy-proven LN patients (82% females) with ≥72 months follow-up at two joint academic centres. Specific criteria for 24-hour proteinuria, estimated glomerular filtration rate (eGFR), renal flares and glucocorticoids dose were set at three time frames (months 0–12, 13–60 and 72) to assess DM. In the first model, DM was achieved if patients fulfilled all four criteria at all three time frames (achievers). In the second model, the continued glucocorticoids reduction criterion was excluded. Logistic regression analyses were performed. Possible different trends in DM achievement between past and recent decades were also investigated.Results DM was achieved by 60% of patients, increased to 70% when glucocorticoids excluded from DM criteria. 24-hour proteinuria at 9 months predicted DM achievement (OR 0.72, 95% CI 0.53 to 0.97, p=0.03), but none of baseline characteristics. Among patients with >72 month follow-up, non-achievers had worse renal outcomes (flares, >30% proteinuria increase, eGFR decline) than achievers at the end of follow-up (median 138 months). Patients diagnosed between 1992 and 2005 were found to have significantly lower percentages of DM achievement and met less often the glucocorticoids dose reduction criterion in all three time frames, compared with those diagnosed between 2006 and 2016 (p=0.006 and p<0.01, respectively).Conclusions DM was achieved by only 60% of LN patients in a real-life setting, partly due to lack of glucocorticoids dose target attainment, while DM failure was associated with worse long-term renal outcomes. This may imply limitations in the effectiveness or implementation of current LN treatments, supporting the need for novel therapeutic strategies.https://rmdopen.bmj.com/content/9/2/e003158.full |
| spellingShingle | Maria G Tektonidou Petros P Sfikakis John Boletis Smaragdi Marinaki Alexandros Panagiotopoulos Ioannis Michelakis Eleni Kapsia Disease modification achievement in patients with lupus nephritis in a real-life setting: mission impossible? RMD Open |
| title | Disease modification achievement in patients with lupus nephritis in a real-life setting: mission impossible? |
| title_full | Disease modification achievement in patients with lupus nephritis in a real-life setting: mission impossible? |
| title_fullStr | Disease modification achievement in patients with lupus nephritis in a real-life setting: mission impossible? |
| title_full_unstemmed | Disease modification achievement in patients with lupus nephritis in a real-life setting: mission impossible? |
| title_short | Disease modification achievement in patients with lupus nephritis in a real-life setting: mission impossible? |
| title_sort | disease modification achievement in patients with lupus nephritis in a real life setting mission impossible |
| url | https://rmdopen.bmj.com/content/9/2/e003158.full |
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