Objectives The optimal duration of immunosuppressive (IS) treatment for lupus nephritis (LN) remains uncertain. We assessed the prevalence and predictors of IS tapering and discontinuation (D/C) in LN patients. Methods Data from 137 inception cohort LN patients were analyzed. We examined determinants of flares during tapering and after IS D/C, D/C achievement and time to D/C, and adverse long-term outcomes applying logistic and linear regression models. Results IS tapering was attempted in 111 (81%) patients, and D/C was achieved in 67.5%. Longer time to achieve complete renal response (CR) (OR : 1.07, p= 0.046) and higher SLEDAI-2K at tapering initiation (OR : 2.57, p= 0.008) were correlated with higher risk of renal flares during tapering. Persistent hydroxychloroquine use (≥2/3 of follow-up) (OR : 0.28, p= 0.08) and lower SLEDAI-2K 12 months before IS D/C (OR : 1.70, p= 0.013) decreased the risk of post-D/C flares. Adverse outcomes (>30% eGFR decline, chronic kidney disease, end-stage renal disease, death) at the end of follow-up (median124 months) were more frequent in patients with flares during IS tapering (53% vs 16%, p< 0.0038) but did not differ between IS D/C achievers and non-achievers. In proliferative LN, differences mirrored those in entire cohort, except for time to D/C, which occurred 20 months earlier in membranous vs proliferative LN (β-coef=-19.8, p= 0.014). Conclusion Earlier CR achievement and lower SLEDAI-2K at tapering initiation prevent flares during IS tapering, while persistent hydroxychloroquine use and lower SLEDAI-2K 12 months before IS D/C prevent post-D/C flares. Flares during tapering increase the risk of unfavorable long-term outcomes. Earlier IS D/C is feasible in membranous LN.

中文翻译：

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狼疮性肾炎肾反应后停用免疫抑制剂：复发的预测因素、停药时间和长期结果


目的 狼疮性肾炎 (LN) 免疫抑制 (IS) 治疗的最佳持续时间仍不确定。我们评估了 LN 患者 IS 逐渐减量和停药 (D/C) 的患病率和预测因素。方法 对 137 名初始队列 LN 患者的数据进行了分析。我们应用逻辑回归模型和线性回归模型研究了减量期间和 IS D/C 之后的耀斑决定因素、D/C 实现和 D/C 时间以及不利的长期结果。结果 111 名 (81%) 患者尝试 IS 逐渐减量，67.5% 的患者实现了 D/C。达到完全肾脏缓解 (CR) 的时间较长（OR：1.07，p = 0.046）和逐渐减量开始时较高的 SLEDAI-2K（OR：2.57，p = 0.008）与逐渐减量期间肾脏复发的较高风险相关。持续使用羟氯喹（随访≥2/3）（OR：0.28，p = 0.08）和 IS D/C 前 12 个月降低 SLEDAI-2K（OR：1.70，p = 0.013）可降低 D 后风险/C 照明弹。随访结束时（中位 124 个月），在 IS 逐渐减量期间出现耀斑的患者中，不良后果（>30% eGFR 下降、慢性肾病、终末期肾病、死亡）更为常见（53% vs 16%，p < 0.0038），但 IS D/C 实现者和非实现者之间没有差异。在增殖性 LN 中，差异反映了整个队列中的差异，但 D/C 时间除外，膜性 LN 与增殖性 LN 相比，D/C 时间早 20 个月（β-coef=-19.8，p= 0.014）。结论 在逐渐减量开始时较早实现 CR 和较低的 SLEDAI-2K 可预防 IS 逐渐减量期间的耀斑，而在 IS D/C 前 12 个月持续使用羟氯喹和较低的 SLEDAI-2K 可预防 D/C 后的耀斑。逐渐减量期间的耀斑会增加不利的长期结果的风险。早期的 IS D/C 在膜液氮中是可行的。