Assessing outcomes in a lupus nephritis cohort over a 40-year period

Abstract

Objectives To characterize a LN cohort over 40 years, assessing its evolution, analysing two major outcomes: the development of end-stage renal disease and mortality rates in the first 5 years after LN diagnosis. Methods An observational retrospective study of patients with LN, followed up from 1975 at University College Hospital. Patients were divided into four groups, depending on the decade of LN diagnosis: 1975–1985 (D1), 1986–1995 (D2), 1996–2005 (D3) and 2006–2015 (D4). Comparison between groups was performed with respect to demographic, clinical, serological and histological characteristics and outcome. Results Two hundred and nineteen patients with LN were studied. There was a change in ethnic distribution, with a decreasing proportion of Caucasians (58.6% in D1 to 31.3% in D4, P = 0.018) and increase in African-ancestry (17.2% in D1 to 39.6% in D4, P = 0.040). Serological and histological patterns changed throughout time, with a reduction in class IV nephritis (51.7% in D1 to 27.1% in D4, P = 0.035), and increase in class II nephritis (10% in D2 to 18.8% in D4, P = 0.01) and anti-extractable nuclear antigen antibody positivity (17.2% in D1 to 83.3% in D4, P = 0.0001). The 5-year mortality rates decreased from D1 (24.1%) to D2 (4%), stabilizing for the next 30 years. The 5-year progression to end-stage renal disease remained stable over the decades. Conclusion Despite the changes in treatment of LN in the past 20 years, we have reached a plateau in 5-year mortality and progression to end-stage renal disease rates, suggesting that new therapeutic and management approaches, and strategies to enhance adherence, are needed to improve outcomes further in LN patients.

Longitudinal analysis of ANA in the Systemic Lupus International Collaborating Clinics (SLICC) Inception Cohort

“…Previous longitudinal examinations of ANA and SLE-related autoantibodies suggest that a patient's ANA status can change from positive to within the normal range and vice versa during the disease course (2,(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16). However, these studies have typically been limited to small, single center cohorts with incomplete disease characterization, short follow-up, and/or using outdated assays with conflicting results.…”

Blood immunophenotyping identifies distinct kidney histopathology and outcomes in patients with lupus nephritis

“…Lupus nephritis (LN) is a common and severe manifestation of systemic lupus erythematosus (SLE) that affects over 40% of patients (1) and substantially increases SLE-associated morbidity and mortality (2)(3)(4). Advances in the understanding of renal inflammatory processes in patients with severe LN (5)(6)(7)(8)(9) have not yet translated into improved renal outcomes (10). Less than half of the patients treated with standard immunosuppressive regimens achieve complete renal response at one year, and 10% to 30% progress to end-stage renal disease (10)(11)(12).…”

Cost-related prescription non-adherence and patient-reported outcomes in systemic lupus erythematosus: The Michigan Lupus Epidemiology & Surveillance program

“…11 We previously documented that one in five adults with SLE in southeastern Michigan reported CRNA within the preceding 12 months, which was twice the rate of general-population controls of similar sociodemographics in the same region; CRNA in SLE was significantly associated with lower income, not having private insurance, and non-White race. 12 Poor medication adherence in SLE is associated with worse outcomes in both patients with renal and non-renal lupus, [13][14][15][16] including increased emergent hospitalizations. 17 A growing literature addressing adherence specifically to hydroxychloroquine in SLE, utilizing objective measures such as drug dispensing data or therapeutic drug monitoring (with blood levels) for this commonly prescribed SLE treatment, has documented a large scope of sub-optimal or non-adherence and association with outcomes such as higher acute care utilization and SLE activity.…”