Attainment of EULAR/ERA-EDTA targets of therapy with current immunosuppressive regimens and adjustments in treatment: a multicentre, real-life observational study
Dimitrios T Boumpas,
Antonis Fanouriakis,
Prodromos Sidiropoulos,
George Bertsias,
Maria G Tektonidou,
Petros P Sfikakis,
Antigone Pieta,
Dimitrios Vassilopoulos,
Maria Pappa,
Paraskevi V Voulgari,
Myrto Nikoloudaki,
Theodoros Dimitroulas,
Andreas Goules,
Charalampos Papagoras,
Christina Tsalapaki,
Kyriaki A Boki,
Harikleia Gakiopoulou,
Maria Kosmetatou,
Evangelia Argyriou,
Aglaia Chalkia,
Georgios Demirtzoglou,
Christina Katsiari,
Nektarios Marios Liapis,
Myrto Cheila,
George Liapis
Affiliations
Dimitrios T Boumpas
4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
Antonis Fanouriakis
4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
Prodromos Sidiropoulos
University Hospital of Heraklion, Crete, Greece, Rheumatology, Clinical Immunology and Allergy, Heraklion, Greece
George Bertsias
Rheumatology and Clinical Immunology, University of Crete,Medical School, Iraklio, Greece
Maria G Tektonidou
First Department of Propaedeutic and Internal Medicine and Joint Academic Rheumatology Program, National and Kapodistrian University of Athens, Athens, Greece
Petros P Sfikakis
First Department of Propaedeutic and Internal Medicine and Joint Academic Rheumatology Program, National and Kapodistrian University of Athens, Athens, Greece
Antigone Pieta
1 Laboratory of Autoimmunity and Inflammation, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
Dimitrios Vassilopoulos
Joint Rheumatology Program,Clinical Immunology-Rheumatology Unit, 2nd Department of Medicine and Laboratory, University of Athens, School of Medicine, Athens, Greece
Maria Pappa
First Department of Propaedeutic Internal Medicine and Joint Rheumatology Program, National and Kapodistrian University of Athens, Medical School, Athens, Greece
Paraskevi V Voulgari
2 Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina Faculty of Medicine, Ioannina, Epirus, Greece
Myrto Nikoloudaki
Rheumatology, Clinical Immunology and Allergy, University of Crete School of Medicine, Heraklion, Crete, Greece
Theodoros Dimitroulas
Aristotle University, 4th Department of Medicine, Thessaloniki, Greece
Andreas Goules
Athens School of Medicine, National and Kapodistrian University of Athens, Athens, Greece., Pathophysiology, Athens, Greece
Charalampos Papagoras
Democritus University of Thrace, Rheumatology Clinic, Thrace, Greece
Christina Tsalapaki
1Joint Rheumatology Program, National and Kapodistrian University of Athens, School of Medicine-Clinical Immunology-Rheumatology Unit, 2nd Department of Medicine, Athens, Greece
Kyriaki A Boki
Rheumatology Unit, Sismanoglion Hospital, Athens, Greece
Harikleia Gakiopoulou
1st Department of Pathology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
Maria Kosmetatou
2Rheumatology Unit, Fourth Dept. of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens, ‘Attikon’ University Hospital, Athens, Greece
Evangelia Argyriou
1Medical School, National and Kapodistrian University of Athens, Department of Physiology, Athens, Greece
Aglaia Chalkia
2Nephrology Department, Hippokratio General Hospital, athens, Greece
Georgios Demirtzoglou
2Rheumatology Unit, Fourth Dept. of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens, ‘Attikon’ University Hospital, Athens, Greece
Christina Katsiari
11Dept. of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
Nektarios Marios Liapis
Faculty of Medicine, School of Health Sciences, University General Hospital of Larissa, Department of Rheumatology and Clinical Immunology, Larissa, Greece
Myrto Cheila
Evangelismos General Hospital of Athens, Rheumatology Clinic, Athens, Greece
George Liapis
National and Kapodistrian University of Athens, School of Medicine, First Department of Pathology, Laiko General Hospital, Athens, Greece
Objective To estimate real-life European Alliance of Associations for Rheumatology (EULAR)/European Renal Association (ERA)-European Dialysis and Transplantation Association (EDTA) response rates and predictors for no response in patients with lupus nephritis (LN) managed with conventional immunosuppressive therapies.Methods Ambidirectional cohort study of patients with new-onset LN (period 2014–to date). Response rates in the first year were calculated, and all treatment modifications were recorded. Univariate and multivariate regression analyses were performed to assess determinants of failure to respond at 12 months.Results 140 patients were included (81.4% women, median (IQR) age at LN diagnosis 38 (22) years). Among them, 32.1% presented with nephrotic range proteinuria, 28.6% with glomerular filtration rate <60 mL/min, 76.6% had proliferative and 19.7% class V LN. Initial treatment consisted of cyclophosphamide in 51.4% of patients (84.7% high-dose, 15.3% low-dose) and mycophenolate in 32.1%. 120 patients had available data at 12 months. EULAR/ERA-EDTA renal response rates at 3, 6 and 12 months were achieved by 72.6%, 78.5% % and 69.2% of patients, respectively. In multivariate analysis, increased Chronicity Index at baseline was associated with failure to achieve either complete or partial response at 12 months (OR 2.26, 95% CI 1.35 to 3.77). Notably, 20% of patients required treatment modifications due to suboptimal response during the first 12 months, with the addition of or switch to a different immunosuppressive drug in seven and nine patients, respectively.Conclusions More than two-thirds of patients with LN attain EULAR/ERA-EDTA response rates by 12 months, but 20% require therapy modifications within this time period. Patients with increased chronicity in baseline biopsy, when combined with histological activity, are at higher risk for a lack of clinical response.
