The following is a summary of “Immunosuppressives discontinuation after renal response in lupus nephritis: predictors of flares, time to withdrawal and long-term outcomes,” published in the July 2024 issue of Rheumatology by Panagiotopoulos et al.

Researchers conducted a retrospective study evaluating the prevalence and predictors of tapering and discontinuation of immunosuppressive (IS) treatment in patients with lupus nephritis (LN), given the uncertainty about the optimal duration.

They analyzed data from 137 patients with LN in an inception cohort. Determinants of flares during tapering and following IS treatment discontinuation (D/C) and the achievement and timing of (D/C) were examined. Logistic and linear regression models were applied to assess adverse long-term outcomes.

The result showed that IS tapering was attempted in 111 (81%) of the 137 patients, with 67.5% achieving D/C. A longer duration to reach complete renal response (CR) (OR: 1.07, P=0.046) and a higher SLEDAI-2K score at the start of tapering (OR: 2.57, P=0.008) were associated with an increased risk of renal flares during tapering. The risk of post-D/C flares was reduced by persistent hydroxychloroquine use (≥2/3 of follow-up) (OR: 0.28, P=0.08) and a lower SLEDAI-2K score 12 months before IS D/C (OR: 1.70, P=0.013). Adverse outcomes (e.g., >30% eGFR decline, chronic kidney disease, end-stage renal disease, death) were more common in patients who experienced flares during IS tapering (53% vs. 16%, P<0.0038) but did not differ between patients who achieved D/C and patients who did not. In proliferative LN, similarities were observed, except that D/C occurred 20 months earlier in the membranous compared to proliferative LN (β-coef = -19.8, P=0.014).

Investigators concluded that early renal response and lower SLEDAI-2K scores prevent flares during tapering and post-D/C, with persistent hydroxychloroquine use reduced post-D/C flares while tapering flares were associated with worse long-term outcomes, and earlier D/C was viable in membranous LN.

Source: academic.oup.com/rheumatology/advance-article/doi/10.1093/rheumatology/keae381/7717969