Recent Study on Immunosuppressive Treatment for Lupus Nephritis: Long-term Results in 178 Patients

Lupus nephritis is one of the most severe Systemic Lupus Erythematosus features, defining treatment
modality and prognosis. Our retrospective study, including 178 patients treated for lupus nephritis
during 23 years with mostly cyclophosphamide-based initial regimens followed by azathioprine or
mycophenolic acid, demonstrates 84.8% of renal response with 19.2% of flares, 15-year patient
survival 78.7% and kidney survival 76.3%, and low damage accrual. Both patient and kidney survival
significantly differ for subgroups that achieved complete or partial renal response and nonresponders:
patient 15-year survival 95% versus 65% versus 35%; kidney 15-year survival 100% versus 58%
versus 0%, respectively. 51% (24 out of 47) of patients evaluated at the end of the study period
sustained complete renal response; however, only 9 of them had 0 disease activity according to
SELENA SLEDAI scale, while 13 patients had scores 2–4 due to the serological abnormalities only.
We conclude that (1) initial treatment with cyclophosphamide followed by azathioprine is effective and
can be used in agreement with International Guidelines until the evidence for biological treatments
benefits becomes available; (2) complete and even partial renal response have positive prognostic
value, and failure to achieve renal response negatively influences kidney and patient survival; (3) the
validity of complete renal response in SLE is questioned by the absence of conventional definition of
SLE remission.