Treatment patterns, treat-to-target goals and clinical outcomes of patients with active lupus nephritis: real-world evidence from a multicentre cohort study

Abstract Background Lupus nephritis (LN) is a common and severe manifestation of systemic lupus erythematosus (SLE). We sought to evaluate treatment patterns, treat-to-target state attainment, and outcomes of patients with active LN on non-biologic, conventional therapy, in a large real-world cohort from the Asia–Pacific region. Methods Adult patients enrolled in a multinational lupus cohort were studied for evidence of active LN, defined based on the SLE Disease Activity Index-2000 (SLEDAI-2K)-proteinuria threshold (> 0.5 g/24 h or > 0.05g/mmol), ≥ 2 visits of data, and no exposure to biologics. The subset of these patients who had kidney biopsy-confirmed LN was retrospectively determined. Attainment of treatment goals, including modified versions of complete renal response (mCRR) and primary efficacy renal response (mPERR), lupus low disease activity state (LLDAS) and DORIS remission (REM), and organ damage accrual, were assessed over time following the first visit with proteinuria. Results One thousand one hundred eighty patients were studied for a median 2.7 [IQR 1.0, 5.0] years, 435 (37%) of whom had biopsies (Class III/IV = 242 (56%)). mCRR, mPERR, LLDAS, and REM were attained at least once during follow-up by 46%, 55%, 60%, and 46% of patients, respectively. mCRR and mPERR attainment was highest at year 2, while LLDAS and REM attainment gradually increased over time. New organ damage accrued in 11% of patients by year 1, increasing to 33% by year 5. Conclusion In a multinational cohort of patients with active LN receiving non-biologic conventional therapy, the attainment of renal responses, LLDAS, and REM was low, while damage accrual was prevalent.