ESPN 53rd Annual Meeting

ESPN 2021


 
Induction therapy for pediatric onset lupus nephritis : Mycophenolate Mofetil versus Cyclophosphamide
LAURYE-ANNE EVEILLARD 1 MARWA CHBIHI 2 QUENTIN RILLER 3 MARION RABANT 4 LAURENE DEHOUX 1 MARINA CHARBIT 1 NATHALIE BIEBUYCK 1 MARINA AVRAMESCU 1 BRIGITTE BADER-MEUNIER 2 OLIVIA BOYER 1

1- SERVICE DE NéPHROLOGIE PéDIATRIQUE, HôPITAL NECKER ENFANTS MALADES, MARHEA, INSTITUT IMAGINE, UNIVERSITé DE PARIS, PARIS, FRANCE
2- UNITé D’IMMUNO-HéMATO-RHUMATOLOGIE PéDIATRIQUE, HôPITAL NECKER ENFANTS MALADES, MARHEA, INSTITUT IMAGINE, UNIVERSITé DE PARIS, PARIS, FRANCE
3- INSERM UMR1163, IMMUNOGENETICS OF PEDIATRIC AUTOIMMUNE DISEASES, IMAGINE – INSTITUT DES MALADIES GéNéTIQUES, PARIS, FRANCE
4- SERVICE DE PATHOLOGIE, HôPITAL NECKER ENFANTS MALADES, INEM, UNIVERSITé DE PARIS, PARIS, FRANCE
 
Introduction:

Class IV lupus nephritis (LN) is one of the most severe involvements in systemic lupus erythematosus and is particularly frequent in case of pediatric onset. The gold standard induction treatment consists of intravenous (IV) pulses of Cyclophosphamide (CYC) in association with corticosteroids. It has considerably improved the renal prognosis but has potential short and long-term toxic effects. Recent studies in adults have shown similar efficacy of oral Mycophenolate Mofetil (MMF) as induction therapy with a lower toxicity. However, the pediatric literature is scarce and current treatment guidelines are extrapolated from the adult population.

The aim of the study was to compare the efficacy and tolerance of CYC and MMF as induction treatment of a first episode of class IV LN in children.

 

Material and methods:

We conducted a monocentric retrospective study including all consecutive children (<18 years) with at least 4 American College of
Rhumatology criteria for lupus, and biopsy-proven class IV LN according to the IRS/RPS classification, and who had not received any prior immunosuppressive treatment.

Results:

Among the 33 patients, 17 had been treated with oral MMF (51%) and 16 with IV CYC. The basic characteristics were similar in both groups except for more neurological involvement in the CYC group (6/17 vs. 0/16). There was a non-significant trend for more severity in the CYC group with higher grade proteinuria, lower albuminuria, and more frequent acute kidney injury.  At one year, 53% of the patients from the MMF group and 77% from the CYC group had achieved remission (p=0.25). 59% of the patients from the MMF group had relapsed, versus 50% of patients from the CYC group (p=0.87), respectively at 3.4 years and 4.7 years after beginning of treatment (p=0.41). The severe and mild complication rates were not significantly different between the two groups.

Conclusions:

In conclusion, we found no difference in the kidney outcome and side effects in children receiving either MMF or CYC as induction therapy of class IV LN. However, in this retrospective study, no patient from the MMF group had neurological involvement, and there was a trend for more severity in the CYC group. Further studies are needed to confirm these results with stratification of children by disease severity.