The efficacy of induction treatment in Thai patients with lupus nephritis: Observational cohort analysis

Background For active proliferative lupus nephritis (LN), intravenous cyclophosphamide (IVCYC) is a standard therapy whereby mycophenolate mofetil (MMF) is less effective than IVCYC, according to the clinical trials in non-Asians. In this observational study, the clinical outcomes will be compared among Thai patients. Methods We had analyzed 93 adult patients who underwent a renal biopsy for active proliferative LN confirmation between January 2013 and June 2021. The assessment of the response outcomes compared the induction treatment of IVCYC versus MMF. The primary endpoint had achieved complete remission (CR) at 24 weeks, while the secondary endpoint is overall remission (OR) and urine protein creatinine ratio (UPCR) changed over time. Results 93 LN patients were separated into two groups; 40 in IVCYC and 53 in MMF. In the 24th week, based on unadjusted analysis, patient had achieved CR 20.0% of IVCYC, whereas 28.3% of MMF had achieved CR. Unadjusted CR Risk difference was −0.08 (95% CI −0.26, −0.09, p-value = 0.351) and the adjusted CR risk difference was −0.19 (95% CI −0.42, 0.04, p-value = 0.098). The unadjusted OR risk difference was −0.06 (95% CI −0.26, 0.14, p-value = 0.553) while adjusted OR risk difference was −0.24 (95% CI −0.50, 0.02, p-value = 0.067). Unadjusted UPCR mean was −0.29 (95% CI −0.77, 0.17, p-value = 0.210) and adjusted UPCR mean was −0.27 (95% CI −0.88, 0.32, p-value = 0.366). Conclusions The induction treatment with either IVCYC or MMF had similar efficacy in Thai LN patients. The decision of treatment should be taken by applying an individualized therapeutic strategy and balancing risks, costs, and benefits.