ESPN 50th Annual Meeting

ESPN 2017


 
TREATMENT FOR INDUCTION OF REMISSION IN LUPUS, WHAT TO CHOOSE?
ADRIAN LUNGU 1 ANDREI CAPITANESCU 2 CAMELIA PANTOC 2 CRISTINA STOICA 1

1- FUNDENI CLINICAL INSTITUTE
2- CAROL DAVILA NEPHROLOGY HOSPITAL
 
Introduction:

 We aimed to evaluate the treatment regimens efficacy for induction in systemic lupus erythematosus (SLE) patients admitted in our referral center.

Material and methods:

We performed a longitudinal retrospective study on 18 patients diagnosed with SLE between 2008-2017. The inclusion criteria were a diagnosis of SLE, clinical, laboratory and treatment data available until remission or 12 months since diagnosis date for those who did not achieve remission. We evaluated all patients and determined the Systemic Lupus Erythematosus Disease Activity Index 2000(SLEDAI2K). A decrease of 4 points or more of SLEDAI2K was used to assess the presence of the remission. We also calculated the SLEDAI2K-variance as the difference between SLEDAI2K at diagnosis and at the end of induction.

Results:

The median age at diagnosis was 14.08 years [12.81;15.77], with female predominance 88.88%. Corticoid (CT) only, associations CYC with CT and MM with CT was administered to 6, 10 and 2 patients, respectively. Sixteen patients achieved remission and the median induction time was 3.5months [2;6.5]. The median SLEDAI2K at baseline was 20[10;27.25]. The median SLEDAI2K-variance was 10.5[5.75;22] (see Table I). Univariate logistic regression showed no statistically significant differences between treatment regimens and induction with a p-value of 0.73.

Conclusions:

With respect to ALMS Trial, our study confirmed that choosing a treatment regimen does not influence induction. We note an improvement of SLEDAI2K when MM is associated with CT vs. when CYC is associated with CT vs. CT only for induction. We admit as limitations of the study the number of patients and that disease activity at diagnosis may bias the selection of agents to treat.

Table I. Lot characteristics depending on treatment regimen

 

Total

CT

CT+CYC

CT+MM

P value

N

18

6 (33.33%)

10 (55.55%)

2 (11.11%)

-

Male

2 (11.11%)

2 (33.33%)

0 (0%)

0 (0%)

0.105

Age

(years)

14.08

[12.81; 15.77]

15.08

[13.31; 16.83]

13.66

[12.36; 14.83]

14.04

[13.33; 14.75]

0.468

Baseline

SLEDAI 2K

20

[10; 27.25]

10

[7.7; 14.8]

21

[17.6; 26.4]

35

[20; 50]

0.105

Achieving remission

16

(88.88%)

6

(100%)

8

(80%)

2

(100%)

0.406

Time to remission (months)

3.5

[2; 6.5]

4

[2; 6.2]

2.5

[2; 4.6]

3

[2;4]

0.636

SLEDAI 2K variance

10.5 [5.75; 22]

6 [4.4; 11.3]

12 [7.6; 22]

23.5 [11; 36]

0.22