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ISSN: 2684-1630
ISSN: 2684-1630
Martin-Gomez MA, Frutos Sanz MA, De Ramon Garrido E, Camps Garcia T, Valiente Sanchis L, Valera Cortes A, Fernandez Nebro A, Garcia Gonzalez I, Toledo Rojas R
Kidney disease has influenced the prognosis of patients with systemic lupus erythematosus (SLE). Fortunately better strategies and new immune-suppressants in the last decades have improved renal and survival prognosis. To study the patient and renal survival and prognostic factors in a cohort of 144 patients with severe lupus nephritis (LN) over a 25-year period at three Southeast Spain centres. We undertook a retrospective analysis of four groups related to time and kind of induction and maintenance treatment. Group A (1985-1990:24 monthly ivcyclophosphamide [ivCyP]); Group B (1991-2000:6 monthly +18 quarterly ivCyP); Group C (2001-2004: fortnightly ivCyP) plus azathioprine [AZT] or mycophenolic acid [MA]; Group D (2005-2010: MA). The whole time of following was 124±86 m. In the first two years, a successful complete or partial response rate was experienced in 92 (77%) without intergroup differences. There was no difference between groups for lupus activity, renal function or proteinuria in repeated measures at 6, 18 and 24 months of following. Overall patient survival by Kaplan Meier test at 5, 10 and 20 years was 92%, 87% and 80%, respectively. The Cox multivariate analysis confirmed that independent prognostic factors for death were older age at diagnosis (Hazard Ratio: 1.05), kidney survival (HR: 1.55) and having an infection (p=0.044). Similarly, overall kidney survival at 5, 10 and 20 years was 91.2%, 80.7% and 61.5%, respectively. The final prognosis factors were higher level baseline creatinine (HR 1.30) and reaching complete remission (HR 0.23). No significant intergroup differences were found concerning kidney and patient survival. Forty five of 115 responder patients (39%) during whole follow-up suffered one or more relapses. Patients maintained with AZA had higher risk to develop a flare. Treatment of severe LN with different strategies adapted to the evolution of knowledge with ivCF or MA were effective and safe, even with regimens that progressively reduce time and doses, leading to a real and hopeful patient and renal survival rate, without differences between groups.