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Lupus nephritis - An update on disparities affecting african americans
Gilda M Portalatin1, Surafel K Gebreselassie2, Shane A Bobart2
1Department of Internal Medicine, Cleveland Clinic Florida, Weston, FL, United States.
Insights
Lupus Nephritis (LN) disproportionately impacts African Americans (AA), leading to severe kidney disease. Addressing healthcare access, clinical trial inclusion, and treatment affordability is crucial for this population.
Area of Science:
- Nephrology
- Immunology
- Health Disparities
Background:
- Lupus Nephritis (LN) is a severe complication of Systemic Lupus Erythematosus (SLE).
- African Americans (AA) experience higher rates of LN progression and end-stage kidney disease.
- Genetic, social, and healthcare access factors contribute to these disparities.
Purpose of the Study:
- To examine the unique challenges faced by African Americans with Lupus Nephritis.
- To highlight disparities in clinical trial representation and treatment affordability.
- To advocate for improved healthcare access and equitable treatment options.
Main Methods:
- Review of clinical manifestations and progression in AA with LN.
- Analysis of factors contributing to health disparities.
- Evaluation of treatment responses and accessibility.
Main Results:
- AA patients often present with higher auto-antibody titers and are prone to severe LN (Class III/IV).
- While mycophenolate mofetil shows benefit in AA, newer agents are often unaffordable.
- African Americans remain underrepresented in clinical trials for novel LN therapies.
Conclusions:
- Significant disparities persist for AA with LN, necessitating systemic changes.
- Improved healthcare access, social support, and clinical trial diversity are essential.
- Affordable and cost-effective treatment options are critical for equitable LN management.
Abstract:
Lupus Nephritis is a complex clinical manifestation of systemic lupus erythematosus (SLE) associated with significant morbidity and mortality. It disproportionately affects minorities, especially African Americans (AA) with higher rates of progression to end stage kidney disease. Several factors are implicated including genetic predisposition to both SLE and chronic kidney disease, social determinants of health such as income inequality, education disparities, social isolation/lack of support, health care access and affordability. Clinically, AA may have higher auto-antibody titers, including several antibodies occurring simultaneously. AA are more prone to severe disease such as Class III and IV lupus nephritis. Fortunately, clinical trials have shown a favorable benefit/response among African Americans to mycophenolate mofetil. However, newer and alternative agents such as Rituximab, Belimumab and Voclosporin are widely unaffordable, and AA remain underrepresented in these clinical trials. The current state of disparities affecting LN patients of AA ancestry is a call for better access to healthcare and social support systems, greater inclusion/representation in clinical trials, and making new and alternative regimens more affordable and cost effective.
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