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Published on: June 8, 2022
Outcomes and Predictors of Treatment Response in Patients With Pure Lupus Membranous Nephropathy
Kevin Chevalier1, Romain Brousse1, Alexandre Karras2
1Department of Nephrology, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, Institut national de la santé et de la recherche médicale (INSERM) CORAKID U155, Sorbonne University, Paris, France.
Introduction:
The indications and modalities of therapeutic strategies for first-onset pure lupus membranous nephropathy (PLMN) remain poorly defined. We aimed to evaluate renal response rates across real-world treatment strategies and identify predictors of treatment response in PLMN.
Methods:
We conducted a multicenter retrospective study in 25 French centers. Patients with biopsy-proven first-onset PLMN treated between 2000 and 2020 were included. Patients were classified according to their initial treatment strategy. Renal response rates were defined based on the 2024 Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. Factors associated with treatment failure at 12 months were assessed using logistic regression.
Results:
Among 194 patients with PLMN, 53 (27.3%) received supportive care only, and 141 (72.7%) received immunosuppressive therapy (54 [38.3%] received mycophenolate mofetil (MMF)-based regimens, 26 [18.4%] received rituximab [RTX]-based regimens, and 61 [43.3%] received other treatments). At 12 months, rates of complete renal response (CRR) and CRR or partial renal (PRR) were respectively, 36.7% and 55.1% with supportive care, 47.1% and 60.8% with MMF, 64.0% and 72.0% with RTX, and 45.4% and 54.5% with other regimens. In multivariable analysis, the presence of anti-U1-ribonucleoprotein (U1RNP) antibodies was independently associated with treatment failure (adjusted odds ratio [OR]: 2.53; 95% confidence interval [CI]: 1.35-4.70; P = 0.004), whereas extrarenal lupus involvement was protective (adjusted OR = 0.39; 95% CI: 0.19-0.73; P = 0.004). RTX-based regimens were significantly associated with shorter treatment duration and corticosteroid sparing.
Conclusion:
In patients with first-onset PLMN, 12-month renal response rates did not differ significantly among immunosuppressive regimens despite variation in treatment duration and steroid exposure. Anti-U1RNP antibodies and absence of extrarenal involvement were associated with a higher risk of treatment failure. Anti-CD20-based strategies may be a promising therapeutic approach.
