Bai Wei, Gui Yinli, Liu Jia, Chen Yunzhuan, Duan Xinwang, Li Hongbin, Wei Wei, Wu Lijun, Liu Shengyun, Wang Yanhong, Jin Shangyi, Wu Chanyuan, Zhao Jiuliang, Wang Qian, Leng Xiaomei, Tian Xinping, Li Mengtao, Zeng Xiaofeng
Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No.1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
Department of Rheumatology, People's Hospital of Zhengzhou: People's Hospital of Henan University of Chinese Medicine, Henan Province, China.
Clin Rheumatol. 2025 Jun 7. doi: 10.1007/s10067-025-07520-x.
Current evidence demonstrates that rigorous adherence to the standardized diagnostic and therapeutic protocols outlined in the European League Against Rheumatism (EULAR) guidelines can markedly enhance renal survival rates in patients with lupus nephritis (LN) and lead to improved overall outcomes. Data on the real-world implementation of LN management guideline in China was limited. This study aimed to examine the implementation of the 2023 EULAR recommendations for systemic lupus erymatosus (SLE) and LN in China.
Based on the Chinese Systemic Lupus Erythematosus Treatment and Research Group (CSTAR) cohort, patients with newly diagnosed active LN (24-h Urine Protein ≥ 0.5 g/L) from April 2009 to March 2022 were included. The initial immunosuppressant therapy, the adjustment of immunosuppressant, and the implementation of renal biopsy at baseline were assessed. The patients' general conditions, clinical manifestations, the condition of rheumatologists and hospitals were included in the analysis.
Of the 1518 enrolled patients, 787 (52%) underwent cyclophosphamide or mycophenolate mofetil as the initial immunosuppressant, which was consistent with the EULAR recommendations. It was associated with longer disease duration, higher disease activity, more mucocutaneous involvement, and younger age of onset. Thirty out of 166 patients (18.1%) failed to achieve renal remission after 6 or 12 months of treatment, and 9 of whom had immunosuppressive therapy adjusted as recommended. Overall, 251 patients (16.5%) underwent renal biopsy at baseline, which were associated with significant renal involvement, unremarkable systemic involvement, and treated by senior rheumatologists.
Management of LN in China showed poor alignment with the 2023 EULAR recommendations regarding initial and adjusted therapy, as well as renal biopsy. The improvement of LN management requires both the patients and the rheumatologists to work together. Key Points • To the best of our knowledge, this is the first real-world implementation study of LN in China. This is also the first real-world implementation study for the newly updated EULAR 2023 recommendation for SLE. • We not only examined the consistency between LN management in China and EULAR recommendations, but also identified potential factors associated with the implementation of the recommendations. • We believe that our study makes a significant contribution to the management of LN.
目前的证据表明，严格遵循欧洲抗风湿病联盟（EULAR）指南中概述的标准化诊断和治疗方案，可显著提高狼疮性肾炎（LN）患者的肾脏存活率，并改善总体预后。关于中国LN管理指南在现实世界中的实施数据有限。本研究旨在探讨2023年EULAR系统性红斑狼疮（SLE）和LN推荐在中国的实施情况。
基于中国系统性红斑狼疮治疗与研究组（CSTAR）队列，纳入2009年4月至2022年3月新诊断的活动性LN（24小时尿蛋白≥0.5g/L）患者。评估初始免疫抑制剂治疗、免疫抑制剂调整以及基线时肾活检的实施情况。分析患者的一般情况、临床表现、风湿病学家和医院的情况。
在1518例纳入患者中，787例（52%）接受环磷酰胺或霉酚酸酯作为初始免疫抑制剂，这与EULAR推荐一致。这与疾病持续时间较长、疾病活动度较高、更多的黏膜皮肤受累以及发病年龄较轻有关。166例患者中有30例（18.1%）在治疗6或12个月后未实现肾脏缓解，其中9例按照推荐调整了免疫抑制治疗。总体而言，251例患者（16.5%）在基线时接受了肾活检，这与显著的肾脏受累、不明显的全身受累以及由资深风湿病学家治疗有关。
中国LN的管理在初始和调整治疗以及肾活检方面与2023年EULAR推荐的一致性较差。LN管理的改善需要患者和风湿病学家共同努力。要点•据我们所知，这是中国首次关于LN的现实世界实施研究。这也是首次对新更新的2023年EULAR SLE推荐进行的现实世界实施研究。•我们不仅研究了中国LN管理与EULAR推荐之间的一致性，还确定了与推荐实施相关的潜在因素。•我们相信我们的研究对LN的管理做出了重大贡献。
