Room for improvement in lupus nephritis outcomes

The first study to look at lupus nephritis (LN) outcomes in Australia in almost 30 years has found that the outlook for the serious complication of SLE can still be poor, particularly for indigenous Australians.

While management of lupus nephritis has improved somewhat in the last two decades, it still relies on long-term use of immunosuppressive agents such as corticosteroids and cytotoxic drugs, which contribute to organ damage, according to a study led by Professor Hans Nossent at the University of WA.

In a retrospective review of 83 cases of lupus nephritis in the state, Professor Nossent and colleagues found that most occurred in non Caucasian subjects, particularly migrants from Asia (29 cases) and Indigenous Australians (11).

However, while the incidence rates for lupus nephritis were up to seven times greater in these ethnic groups, this could not be explained by differences in clinical age, gender or serological biomarkers for lupus nephritis such as anti-dsDNA Ab levels or hypocomplementaemia.

Similarly, although most patients had timely renal biopsy as recommended in guidelines, there were very few distinguishing biopsy findings between ethnic subgroups, “suggesting that these histological measures fail to capture the intrinsic propensity for lupus nephritis determined by ethnic background,” the study authors wrote in the journal Lupus.

The review found there had been a switch away from treatment with cyclophosphamide to use of mycophenolate-mofetil (MMF) based induction and maintenance treatment for lupus nephritis, following its approval in 2008 in Australia.

Good outcomes from treatment were seen for Asian and Caucasian patients, among whom overall survival and renal rates at five and ten years were over 95%. However for indigenous patients the five- (81%) and 10-year (70%) survival rates were significantly lower than than for Caucasians and Asians and likewise, five- and 10-year renal survival (endpoint renal replacement therapy) rates were 86% and 64% respectively.

These findings showed that treatment “initiated early within the window of opportunity can reduce the risk of renal failure by preventing scarring,” the authors said.

However, while most patients still received long term steroids and immunomodulator drugs only 25% of patients remained free of any organ damage. Many patients did not receive bone protection therapies and more than 50% had non-renal organ damage including cardiovascular events (13%), cataract (10%), joint deformity (10%), malignancy (10%), spinal fractures (7%) and diabetes mellitus (7%).

“With current management the outlook for Asian patients is now similar to that for Caucasian patients, but this does not hold true for Indigenous Australians,” the researchers concluded.

“Also, there is very limited predictive value for histological and clinical findings other than ethnic background,” they added.

Already a member?

Login to keep reading.

Email me a login link

© 2022 the limbic