Can Low Lupus Activity Predict Outcomes in Lupus Nephritis?
Although the lupus low disease activity state (LLDAS) has seldom served as a treatment goal in patients with lupus nephritis, it proved an attainable target and effectively predicted the risk for disease relapse — whether used alone or alongside conventional treatment targets.
METHODOLOGY:
Researchers analyzed 143 patients with biopsy-proven active lupus nephritis (median age at onset of lupus, 28 years; 92% women) at a tertiary hospital in Hong Kong to assess rates of LLDAS attainment and LLDAS's predictive ability for relapse compared with that of conventional treatment targets.
Patients received induction treatment with high-dose glucocorticoids and immunosuppressants, followed by maintenance therapy, and were monitored at least every 4 months for clinical and laboratory assessments.
Achievement rates of conventional treatment targets (complete/partial renal response) and LLDAS were assessed at 12 months after the biopsy date.
Relapse of lupus nephritis was suspected when proteinuria and/or urinary sediments worsened and/or levels of serum creatinine rose; relapse was confirmed using renal biopsy.
Findings were validated in 102 patients (median age at onset of lupus, 30 years; 87% women) from another tertiary hospital in Hong Kong who also attended regular follow-up visits.
TAKEAWAY:
At 12 months, 40% of 143 patients achieved complete renal response, 10% achieved partial renal response, and 49% achieved LLDAS, indicating that LLDAS is an attainable target comparable to renal response.
Patients who achieved neither LLDAS nor complete/partial renal response at 12 months had the highest risk for relapse of lupus nephritis, those who achieved either target had an intermediate risk, and those who achieved both targets had the lowest risk.
Further analysis revealed an independent association of achieving complete/partial renal response (hazard ratio [HR], 0.31; P = .007) and LLDAS (HR, 0.38; P = .029) with a reduced risk for disease relapse, with findings validated in the validation cohort as well.
Achieving LLDAS also predicted the preservation of renal function, with satisfactory performance in both cohorts (area under the curve, 0.71).
IN PRACTICE:
'Our findings demonstrate promise in the potential application of LLDAS as a treatment target and endpoint for future LN [lupus nephritis] trials,' the authors of the study wrote.
SOURCE:
The study was led by Chak Kwan Cheung, MBBS, Queen Mary Hospital, the University of Hong Kong in Pok Fu Lam, Hong Kong. It was published online on July 20, 2025, in Arthritis Care & Research.
LIMITATIONS:
The study included only Chinese patients. The 12-month renal response included both complete and partial renal responses, with their individual effects on subsequent renal outcomes not evaluated separately.
DISCLOSURES:
The study received no financial support. Two authors declared receiving payment or honoraria, support for attending meetings or travelling, having leadership roles, and other ties with certain pharmaceutical companies and organizations.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
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