Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Repeat Kidney Biopsies Fail To Detect Differences between Azathioprine and Mycophenolate Mofetil Maintenance Therapy for Lupus Nephritis: Data from the MAINTAIN Nephritis Trial.

Stoenoiu1,  Maria, Aydin1,  Selda, Vasconcelos4,  Carlos, Tektonidou5,  Maria, Ravelingien6,  Isabelle, Guern2,  Véronique le, Depresseux1,  Geneviève

Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Bruxelles, Belgium
Hôpital Cochin, Paris, France
Hospital Clinic, Barcelona, Spain
Hospital Santo Antonio, Porto, Portugal
National University of Athens, Athens, Greece
O.L. Vrouwziekenhuis, Aalst, Belgium

Introduction:

In the MAINTAIN Nephritis Trial, an investigator led randomized study, azathioprine (AZA) and mycophenolate mofetil (MMF) were compared as maintenance immunosuppressive treatment of proliferative lupus nephritis (LN) after a short course of low-dose (6 × 500 mg q2w; Euro-Lupus) intravenous cyclophosphamide. Although more renal flares were observed in AZA (25%) compared to MMF patients (19%), time to renal flare by Kaplan-Meier analysis did not statistically differ. Per protocol repeat kidney biopsies were available in 26 patients. Here we compare the pathological findings between the two groups.

Methods:

105 lupus patients with biopsy-proven proliferative nephritis were included in the MAINTAIN Nephritis Trial. Per protocol repeat renal biopsies were performed between month 18 and 30 in 26 patients (all females; 15 AZA and 11 MMF). All 26 patients had been treated exactly according to the protocol, i. e. had stayed on the same immunosuppressant and had tapered the steroids as requested. Biopsies were classified according to the ISN/RPS classification. The activity index (AI, max 42) and the chronicity index (CI, max 6) were calculated using the semi-quantitative scoring system of Morel-Maroger. Statistics were by non-parametric tests.

Results:

Baseline and follow-up renal parameters of AZA and MMF patients did not differ. Time (SD) to repeat renal biopsy was 24.7 (1.7) and 25.1 (2.1) months in AZA and MMF patients, respectively. In both groups, the activity index dramatically and statistically decreased at follow up compared to baseline, while the chronicity index slightly but statistically increased. No between groups differences could be detected. In a second analysis, we added 4 patients for whom a repeat renal biopsy was also available, within the same time frame, but who had been switched to another immunosuppressant due to a renal flare which had occurred before the second biopsy. Baseline and follow up AI and CI on these 30 (26+4) paired renal biopsies were exactly comparable to the data obtained on the 26 patients.

Conclusion:

No differences were observed on repeat kidney biopsies between patients treated with AZA or MMF.

To cite this abstract, please use the following information:
Stoenoiu, Maria, Aydin, Selda, Vasconcelos, Carlos, Tektonidou, Maria, Ravelingien, Isabelle, Guern, Véronique le, et al; Repeat Kidney Biopsies Fail To Detect Differences between Azathioprine and Mycophenolate Mofetil Maintenance Therapy for Lupus Nephritis: Data from the MAINTAIN Nephritis Trial. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1398
DOI: 10.1002/art.29164

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