Long-term outcomes with multi-targeted immunosuppressive protocol in children with severe proliferative lupus nephritis

We have previously reported the one-year outcomes of 16 children with severe proliferative lupus nephritis (LN) who were treated using a multi-targeted induction protocol based on intravenous (IV) pulse methylprednisolone (MP), mycophenolate mofetil (MMF) and cyclosporine (CSA). This study examined the long-term renal outcomes of these 16 children, followed up for a median duration of 9.2 years (range 5.8-14.2 years). Primary treatment outcome was complete renal remission. Secondary outcomes included patient and renal survival as well as relapse-free and event-free survival. All patients achieved complete renal remission within 24 months (median 8.7 months, range 4.0-24.0 months). Comparing clinical and laboratory parameters at induction and last follow-up, respectively, Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score (25.4 +/- 8.7 vs 0.4 +/- 0.8), serum complement C3 (47 +/- 21 vs 107 +/- 27 mg/dL), estimated glomerular filtration rate (eGFR) (72 +/- 57 vs 109.7 +/- 43 ml/min/1.73m 2) and urine protein (6.97 +/- 7.09 vs 0.2 +/- 0.02 g/day/1.73m(2)) improved significantly (p < 0.05). Kaplan-Meier survival analysis showed a cumulative ten-year renal relapse-free survival of 73.3% when considering relapses with severe proteinuria > 1 g/day/1.73m(2). Cumulative probability that hospitalization would not be required was 93.8% at one year, and 71.4% at ten years. Our multi-targeted protocol for induction and maintenance therapy in Asian children with severe proliferative LN resulted in good long-term patient survival and renal preservation, with a good safety profile.