Lupus & antiphospholipid syndrome
Real-world discontinuation of immunosuppressive therapy after proliferative lupus nephritis: the overlooked impact of non-adherence (MASSILUP-WIN)
Authors' conclusion
In routine clinical practice, more than half of patients with pLN discontinue IST, and a substantial proportion of discontinuations occur outside a planned withdrawal strategy. Non-adherence was the factor most strongly associated with renal relapse, identifying a high-risk subgroup often excluded from treatment withdrawal studies. These findings highlight the importance of therapeutic alliance and patient education when considering IST discontinuation in LN.
Study context
- Population
- All patients with a first biopsy-proven proliferative lupus nephritis (pLN) diagnosed in Marseille, France, between 2001 and 2022patients with pLN followed for a median of 10.1 years
- Participants
- 124 patients
- Exposure
- Physician-guided discontinuation vs discontinuation related to non-adherence
- Outcome
- IST discontinuation at least once
Methodological detailstime-to-event analyses
- Time-to-event analyses
Main finding
As reported in the abstract
Discontinued immunosuppressive therapy (IST) at least once
71
57.3%
Median treatment duration before discontinuation
39 months
Observational data: associations, not effects.
Further findings
Cumulative incidence of renal relapse · 5 years
P < 0.001
Reasons for discontinuation (among those who discontinued)
- Physician-guided withdrawal in renal remission
- 60.6%
- Non-adherence
- 15.5%
Course after first discontinuation
- Remained off IST
- 33 patients (46.5%)
- Resumed IST
- 33
- Developed end-stage renal disease or died
- five
Renal relapse among the 58 patients in renal remission at discontinuation
- Renal relapse, of the 58 patients in renal remission at discontinuation
- 21 (36.2%)
- Median time to renal relapse
- 3.1 years
Factors associated with renal relapse
- Non-adherence, HR
- 4.72 (95% CI 1.79 to 12.48)
- Low complement levels at discontinuation, younger age and shorter duration of renal remission also associated with renal relapse
Original publication
Composed by AI from the published abstract and checked against it. How Briefs are made →