Immunosuppressant withdrawal viable in lupus nephritis

A recent study reports that it is feasible to discontinue immunosuppressive therapy (IS) in lupus nephritis (LN) patients who have been in remission for at least 3 years and on antimalarial therapy. In those who develop flares after withdrawal, remission can be recaptured with appropriate treatment.

Researchers looked at 513 systemic lupus erythematosus (SLE) patients, among whom 270 had LN. In the LN group, 238 underwent renal biopsy and received treatment with IS. Those who exhibited normal serum creatinine, proteinuria <0.5 g/24 h, inactive urine sediment, and no extra-renal SLE activity on stable immunosuppressive and/or antimalarial therapy and/or prednisone ≤5 mg/day were in remission.

A total of 83 patients (34.8 percent) discontinued IS 46 months after achieving remission. Over a mean follow-up of 116.5 months, 19 patients (22.8 percent) experienced a flare (8 out of 19 were renal) and received retreatment. Remission was recaptured in 14 out of 19 (73.7 patients) after restarting therapy.

The risk of relapse was notably lower among patients treated with IS therapy for at least 3 years after remission achievement (odds ratio [OR], 0.284, 95 percent confidence interval [CI], 0.093–0.867; p=0.023).

Several factors emerged as protective against disease flare in multivariate analysis. These included antimalarial maintenance therapy (OR, 0.194, 95 percent CI, 0.038–0.978; p=0.047), age at IS discontinuation (OR, 0.93, 95 percent CI, 0.868–0.997; p=0.040), and remission duration of >3 years prior to IS discontinuation (OR, 0.231, 95 percent CI, 0.058–0.920; p=0.038).