Multitarget therapy for maintenance treatment of lupus nephritis

Abstract

Our previous studiesshowedthat multitarget therapy is superior in efficacy to intravenous cyclophosphamide as an induction treatment for lupus nephritis in Asian populations. We conducted an open label, multicenter study for 18 months as an extension of the prior induction therapy trial in 19 renal centers in China to assess the efficacy and safety of multitarget maintenance therapy in patients who had responded at 24 weeks during the induction phase. Patientswho had undergone multitarget induction therapy continued to receive multitarget therapy (tacrolimus, 2-3mg/d; mycophenolatemofetil, 0.50-0.75 g/d; prednisone, 10mg/d), and patientswho had received intravenous cyclophosphamide induction treatment received azathioprine (2 mg/kg per day) plus prednisone (10 mg/d). We assessed the renal relapse rateduringmaintenance therapy as the primaryoutcome.We recruited116patients in the multitarget group and 90 patients in the azathioprine group. The multitarget and azathioprine groups had similar cumulative renal relapserates (5.47%versus 7.62%,respectively; adjustedhazard ratio,0.82;95%confidence interval, 0.25 to 2.67; P=0.74), and serum creatinine levels and eGFR remained stable in both groups. The azathioprine group had more adverse events (44.4% versus 16.4% for multitarget therapy; P,0.01), and the multitarget group had a lower withdrawal rate due to adverse events (1.7% versus 8.9% for azathioprine; P=0.02). In conclusion, multitarget therapy as amaintenance treatment for lupus nephritis resulted in a low renal relapse rate and fewer adverse events, suggesting thatmultitarget therapy is an effective and safe maintenance treatment for patients with lupus nephritis.