Vidal-Montal Paola, Narváez Javier, Fulladosa Xavier, Mitjavila Francesca, Capdevila Olga, Torras Joan, Gomà Montserrat, Nolla Joan M
Department of Rheumatology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.
Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.
Lupus Sci Med. 2025 Jan 19;12(1):e001375. doi: 10.1136/lupus-2024-001375.
To investigate the rate and factors influencing renal relapse (RR) in proliferative lupus nephritis (LN) patients who discontinued immunosuppressive therapy (IST), as well as the long-term renal outcomes following RR.
Retrospective, single-centre study of biopsy-confirmed LN patients who had received IST for at least 36 months and maintained complete renal response (CRR) for a minimum of 12 months before therapy discontinuation.
Of a total of 106 patients meeting the inclusion criteria, 76 with proliferative classes were selected for analysis. The median duration of IST prior to discontinuation was 83.5 months (IQR 25th-75th: 53.5-120). Relapse occurred in 29 patients (38.2%) at a median of 26.5 months (IQR 25th-75th: 9.25-63.5 months) following IST withdrawal. Relapses were classified as severe in 9 cases (31%) and moderate in 16 cases (55.2%). Renal rebiopsy was performed in 25 of these patients (86.2%), with 80% retaining the same histological class.Discontinuation of IST at ≤34 years of age significantly increased the risk of RR (adjusted HR: 3.5). In contrast, an IST duration exceeding 48 months prior to discontinuation (HR: 0.26), maintaining CRR for at least 48 months (HR: 0.32), achieving complete remission per DORIS (definition of remission in systemic lupus erythematosus) criteria at IST withdrawal (HR: 0.21) and gradual IST tapering (HR: 0.09) were associated with a reduced risk of RR.Following reintroduction of IST, 20 out of 29 patients (68.9%) achieved CRR, 5 (17.2%) achieved a partial response and 4 (13.8%) did not respond; of these, 3 patients (10.3%) progressed to end-stage renal disease.
Successful withdrawal of IST is possible in carefully selected patients with proliferative LN. If an RR occurs, most patients are able to remain in remission after resuming IST.
探讨停止免疫抑制治疗（IST）的增殖性狼疮性肾炎（LN）患者的肾脏复发（RR）率及影响因素，以及RR后的长期肾脏结局。
对经活检确诊、接受IST至少36个月且在治疗停止前维持完全肾脏缓解（CRR）至少12个月的LN患者进行回顾性单中心研究。
共有106例符合纳入标准的患者，其中76例增殖型患者被选入分析。停止IST前的中位治疗时间为83.5个月（四分位间距第25 - 75百分位数：53.5 - 120）。29例患者（38.2%）在停止IST后的中位时间26.5个月（四分位间距第25 - 75百分位数：9.25 - 63.5个月）出现复发。9例（31%）复发为重度，16例（55.2%）为中度。其中25例患者（86.2%）进行了肾脏重复活检，80%维持相同的组织学类型。≤34岁停止IST显著增加RR风险（校正风险比：3.5）。相反，停止IST前治疗时间超过48个月（风险比：0.26）、维持CRR至少48个月（风险比：0.32）、停止IST时根据DORIS（系统性红斑狼疮缓解定义）标准达到完全缓解（风险比：0.21）以及逐渐减少IST剂量（风险比：0.09）与RR风险降低相关。重新引入IST后，29例患者中有20例（68.9%）达到CRR，5例（17.2%）达到部分缓解，4例（13.8%）无反应；其中3例患者（10.3%）进展为终末期肾病。
在经过精心挑选的增殖性LN患者中，成功停用IST是可行的。如果发生RR，大多数患者在恢复IST后能够保持缓解状态。
